MEDICARE: REVIVAL HOME HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	7001629	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134114176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVAL HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	5350 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6703
Country	:	US
Telephone Number	:	718-629-1000
Fax Number	:	718-629-5151

Provider Business Practice Location Address
First Line	:	5350 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6703
Country	:	US
Telephone Number	:	718-629-1000
Fax Number	:	718-629-5151

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACOB SPITZER
Credential	:
Telephone Number	:	718-629-1000

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	08/22/2020

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