Healthcare Provider Details

I. General information

NPI: 1134514367
Provider Name (Legal Business Name): REVERE HOMECARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 HICHBORN ST
REVERE MA
02151-5138
US

IV. Provider business mailing address

182 HICHBORN ST
REVERE MA
02151-5138
US

V. Phone/Fax

Practice location:
  • Phone: 857-928-0784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BUSTAMANTE
Title or Position: DIRECTOR
Credential:
Phone: 857-928-0784