Provider Demographics
NPI:1679040570
Name:REVIVIFY HOME HEALTH CARE
Entity Type:Organization
Organization Name:REVIVIFY HOME HEALTH CARE
Other - Org Name:REVIVIFY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KULIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-967-5090
Mailing Address - Street 1:10201 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2501
Mailing Address - Country:US
Mailing Address - Phone:818-967-5090
Mailing Address - Fax:818-967-5091
Practice Address - Street 1:10201 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2501
Practice Address - Country:US
Practice Address - Phone:818-967-5090
Practice Address - Fax:818-967-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health