MEDICARE: REVITALIZE NOW HEALTH AND WELLNESS LLC

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	174H00000X	Health Educator
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1649133810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVITALIZE NOW HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	45 S VINE ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-3822
Country	:	US
Telephone Number	:	203-584-0815
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 S VINE ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-3822
Country	:	US
Telephone Number	:	203-584-0815
Fax Number	:	862-343-9530

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER BROWN-CAPLE
Credential	:	LPN
Telephone Number	:	203-584-0815

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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