Healthcare Provider Details

I. General information

NPI: 1235953548
Provider Name (Legal Business Name): REVIVE HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 TOWN CENTER PKWY UNIT 135
LAKEWOOD RANCH FL
34202-5308
US

IV. Provider business mailing address

9015 TOWN CENTER PKWY UNIT 135
LAKEWOOD RANCH FL
34202-5308
US

V. Phone/Fax

Practice location:
  • Phone: 941-263-8058
  • Fax: 941-263-8074
Mailing address:
  • Phone: 941-263-8058
  • Fax: 941-263-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAYANKKUMAR BALADEVBHAI PATEL
Title or Position: CFO
Credential:
Phone: 845-903-2312