MEDICARE: REVIVAL HOME HEALTH CARE SERVICES, INC

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	253Z00000X	In Home Supportive Care Agency
2	251J00000X	Nursing Care Agency
3	251E00000X	Home Health Agency	011982	TX

General Provider Information

NPI Number	:	1144479924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVAL HOME HEALTH CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	6275 W PLANO PKWY STE 500
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4942
Country	:	US
Telephone Number	:	469-633-9551
Fax Number	:	469-633-9555

Provider Business Practice Location Address
First Line	:	6275 W PLANO PKWY STE 500
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4942
Country	:	US
Telephone Number	:	463-633-9557
Fax Number	:	469-633-9555

Authorized Official
Title or Position	:	DIRECTOR OF NURSES/ADMINISTRATOR
Name	:	MRS. CHRISTIANA NGOZI UDEZE
Credential	:	RN
Telephone Number	:	469-633-9557

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	03/02/2026

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