Organization
REVIVAL HEALTH HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOLIVAR ALTAMIRANO (MR.)
(347) 605-0410
Entity
Organization
Contact information
Practice address
1129 GLENN ST, LANSING, MI 48915-2115
(347) 605-0410
Mailing address
2-06 ASTORIA BLVD, 2E, ASTORIA, NY 11102
(347) 605-0410
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
07/25/2024
Last updated
03/03/2026
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