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General NPI Number Information
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NPI Number | 1487158440
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Entity Type | Organization
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Legal Business Name | REVIVE HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 10174 W FLORISSANT AVE STE 331
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City | SAINT LOUIS
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State | MO
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Zip | 63136-2104
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Country | US
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Telephone | 314-449-1060
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Fax | 314-754-8306
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Provider Business Mailing Address
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Address Line | 210 N 17TH ST STE 102A
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City | SAINT LOUIS
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State | MO
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Zip | 63103-2518
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Country | US
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Telephone | 314-449-1060
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Fax | 314-669-9921
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Authorized Official
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Title or Position | OWNER
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Name | MR. LAMONT FLEMON SR.
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Credential |
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Telephone | 314-825-0997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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