Provider Demographics
NPI:1649586702
Name:REVIVAL HOME HEALTH CARE, LLC.
Entity Type:Organization
Organization Name:REVIVAL HOME HEALTH CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-799-3380
Mailing Address - Street 1:24681 NORTHWESTERN HWY.
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2321
Mailing Address - Country:US
Mailing Address - Phone:248-799-3380
Mailing Address - Fax:248-799-0671
Practice Address - Street 1:24681 NORTHWESTERN HWY.
Practice Address - Street 2:SUITE 404
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2321
Practice Address - Country:US
Practice Address - Phone:248-799-3380
Practice Address - Fax:248-799-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health