OrganizationRevived Minds LlcCommunity/Behavioral HealthAgenciesPractice Address6212 W Charleston Blvd # 14, Las Vegas, NV 89146-1163(818) 232-6452PECOS EnrollmentBased on the most recent information from CMS, provider Revived Minds Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1033832324Provider TypeOrganizationFull NameRevived Minds LlcSubpartNoEnumeration Date9/21/2022Last Updated4/10/2024Contact InformationPractice LocationPractice Address6212 W Charleston Blvd # 14, Las Vegas, NV 89146-1163Phone(818) 232-6452FaxUnlisted FaxMailing LocationMailing Address6212 W Charleston Blvd # 14, Las Vegas, NV 89146-1163Phone(818) 232-6452FaxUnlisted FaxAuthorized OfficialNameChapman, Tisto (Administrator)Phone(818) 232-6452Provider TaxonomiesCodeDescriptionLicenseCode251S00000XPrimaryDescriptionCommunity/Behavioral HealthAgenciesLicenseUnlisted Issuer