Healthcare Provider Details

I. General information

NPI: 1659230464
Provider Name (Legal Business Name): CAP REVIVAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2026
Last Update Date: 01/17/2026
Certification Date: 01/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10446 CARLOWAY HILLS DR
WIMAUMA FL
33598-6204
US

IV. Provider business mailing address

10446 CARLOWAY HILLS DR
WIMAUMA FL
33598-6204
US

V. Phone/Fax

Practice location:
  • Phone: 813-244-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: COLLIN PLUMMER
Title or Position: OWNER
Credential:
Phone: 813-244-5520