Healthcare Provider Details

I. General information

NPI: 1649133810
Provider Name (Legal Business Name): REVITALIZE NOW HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S VINE ST
MERIDEN CT
06451-3822
US

IV. Provider business mailing address

45 S VINE ST
MERIDEN CT
06451-3822
US

V. Phone/Fax

Practice location:
  • Phone: 203-584-0815
  • Fax: 862-343-9530
Mailing address:
  • Phone: 203-584-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AMBER BROWN-CAPLE
Title or Position: OWNER
Credential: LPN
Phone: 203-584-0815