MEDICARE: REVATI HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1003786146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVATI HOME CARE LLC

Provider Business Mailing Address
First Line	:	4813 LAUDERDALE AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1364
Country	:	US
Telephone Number	:	313-264-7589
Fax Number	:

Provider Business Practice Location Address
First Line	:	4813 LAUDERDALE AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1364
Country	:	US
Telephone Number	:	313-264-7589
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SARAH RENE HERRERA
Credential	:	RN
Telephone Number	:	313-264-7589

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	11/05/2025

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