Provider Demographics
NPI:1750139655
Name:REVIVED HANDS LLC
Entity type:Organization
Organization Name:REVIVED HANDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CHINECHEREM
Authorized Official - Middle Name:G
Authorized Official - Last Name:EGBUDIWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-874-8804
Mailing Address - Street 1:2220 GUS THOMASSON RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5367
Mailing Address - Country:US
Mailing Address - Phone:469-928-9141
Mailing Address - Fax:
Practice Address - Street 1:2220 GUS THOMASSON RD BLDG B
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5367
Practice Address - Country:US
Practice Address - Phone:469-928-9141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care