Healthcare Provider Details

I. General information

NPI: 1487158440
Provider Name (Legal Business Name): REVIVE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10174 W FLORISSANT AVE STE 331
SAINT LOUIS MO
63136-2104
US

IV. Provider business mailing address

210 N 17TH ST STE 102A
SAINT LOUIS MO
63103-2518
US

V. Phone/Fax

Practice location:
  • Phone: 314-449-1060
  • Fax: 314-754-8306
Mailing address:
  • Phone: 314-449-1060
  • Fax: 314-669-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LAMONT FLEMON SR.
Title or Position: OWNER
Credential:
Phone: 314-825-0997