Provider Demographics
NPI:1871332528
Name:REVIVEWELL HOME REHABILITATION SERVICES INC
Entity type:Organization
Organization Name:REVIVEWELL HOME REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUENAS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:914-552-5628
Mailing Address - Street 1:6 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1414
Mailing Address - Country:US
Mailing Address - Phone:914-552-5628
Mailing Address - Fax:
Practice Address - Street 1:6 QUAKER RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1414
Practice Address - Country:US
Practice Address - Phone:914-552-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty