# REVIVAL HEALTH HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821826207
- **Authorized official:** BOLIVAR ALTAMIRANO (MR.)
- **Authorized official phone:** (347) 605-0410

## Contact information

- **Practice address:** 1129 GLENN ST, LANSING, MI 48915-2115
- **Practice address phone:** (347) 605-0410
- **Mailing address:** 2-06 ASTORIA BLVD, 2E, ASTORIA, NY 11102
- **Mailing address phone:** (347) 605-0410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 251X00000X | Supports Brokerage Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/25/2024
- **Last updated:** 03/03/2026