Healthcare Provider Details

I. General information

NPI: 1396567426
Provider Name (Legal Business Name): REVIVE IN ACTION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BEAR HILL RD STE 103
WALTHAM MA
02451-1004
US

IV. Provider business mailing address

220 BEAR HILL RD STE 103
WALTHAM MA
02451-1004
US

V. Phone/Fax

Practice location:
  • Phone: 781-227-5692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: REBECCA JEAN
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 781-227-5692