Provider Demographics
NPI:1215307608
Name:REVIVE HOME HEALTH CARE
Entity type:Organization
Organization Name:REVIVE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLEMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-825-0997
Mailing Address - Street 1:10174 W FLORISSANT AVE STE 331
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2104
Mailing Address - Country:US
Mailing Address - Phone:314-449-1060
Mailing Address - Fax:314-925-1311
Practice Address - Street 1:10174 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2104
Practice Address - Country:US
Practice Address - Phone:314-449-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health