Provider Demographics
NPI:1831558717
Name:REVITALIFE HOME HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:REVITALIFE HOME HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IBANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-460-8707
Mailing Address - Street 1:9898 BISSONNET ST STE 320
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8051
Mailing Address - Country:US
Mailing Address - Phone:832-460-8707
Mailing Address - Fax:844-269-6770
Practice Address - Street 1:9898 BISSONNET ST STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8051
Practice Address - Country:US
Practice Address - Phone:832-460-8707
Practice Address - Fax:844-269-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health