Provider Demographics
NPI:1588427793
Name:REVIVE RESTORE CONSULTING HOMECARE
Entity type:Organization
Organization Name:REVIVE RESTORE CONSULTING HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MERRIWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-210-8322
Mailing Address - Street 1:22266 CIVIC CENTER DR APT 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2632
Mailing Address - Country:US
Mailing Address - Phone:248-210-8322
Mailing Address - Fax:
Practice Address - Street 1:22266 CIVIC CENTER DR APT 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2632
Practice Address - Country:US
Practice Address - Phone:248-210-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health