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General NPI Number Information
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NPI Number | 1659577724
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Entity Type | Organization
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Legal Business Name | REVIVAL HOME HEALTH CARE AGENCY INC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 5101C BACKLICK RD STE 2
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City | ANNANDALE
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State | VA
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Zip | 22003-6061
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Country | US
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Telephone | 888-225-6905
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Fax | 888-801-4714
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Provider Business Mailing Address
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Address Line | 5101C BACKLICK RD STE 2
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City | ANNANDALE
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State | VA
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Zip | 22003-6061
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Country | US
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Telephone | 888-225-6905
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Fax | 888-801-4714
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Authorized Official
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Title or Position | PRESIDENT &CEO
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Name | DR. AKRAM ELZEND
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Credential | PT, DPT, MBA&M
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Telephone | 888-225-6905
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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 | HCO08450
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License Number State | VA
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