Organization
REVIVE HOME INFUSION THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILIYA HERETSUN-ROUSSONICOLOS (OWNER)
(772) 207-6266
Entity
Organization
Contact information
Practice address
354 W FAIRBANKS AVE, WINTER PARK, FL 32789-5093
(321) 972-4243
(321) 972-4214
Mailing address
354 W FAIRBANKS AVE, WINTER PARK, FL 32789-5093
(321) 972-4243
(321) 972-4214
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
—
—
Other
Enumeration date
04/13/2021
Last updated
04/13/2021
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