Provider Demographics
NPI:1770474264
Name:REVIVAL HOME CARE
Entity type:Organization
Organization Name:REVIVAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASEUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-518-0622
Mailing Address - Street 1:7722 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-2720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7722 N 29TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2720
Practice Address - Country:US
Practice Address - Phone:402-518-0622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-12
Last Update Date:2025-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health