MEDICARE: REVIVE HOME HEALTH 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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487158440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	210 N 17TH ST STE 102A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2518
Country	:	US
Telephone Number	:	314-449-1060
Fax Number	:	314-669-9921

Provider Business Practice Location Address
First Line	:	10174 W FLORISSANT AVE STE 331
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2104
Country	:	US
Telephone Number	:	314-449-1060
Fax Number	:	314-754-8306

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LAMONT FLEMON SR.
Credential	:
Telephone Number	:	314-825-0997

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	12/17/2025

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Directions to “REVIVE HOME HEALTH CARE LLC ” Practice Location

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