Organization
REVIVE 45 INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVINA HAMILTON (OWNER)
(773) 242-9408
Entity
Organization
Contact information
Practice address
10544 S HARLEM AVE # 205, PALOS HILLS, IL 60465-2063
(773) 242-9408
Mailing address
9110 S SPAULDING AVE, EVERGREEN PARK, IL 60805-1550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/24/2023
Last updated
03/10/2025
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