Revitalize Care Home

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

REVITALIZE CARE HOME

Doing business as

ReVitalize Care Home

Practice address

1913 Cardiff Dr
Pittsburg, CA 94565-4049

Phone

(925) 267-9822

NPI assigned

Sep 4, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Genevieve Dace, NPNPI 1396991360

Title

Owner

Phone

(925) 623-6094

Specialties & licenses 1

Addresses

Other names 1

• ReVitalize Care Home Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Genevieve Dace, N.P.

  • Primary Care Clinic/Center
  • Pittsburg, CA
  • NPI 1396991360
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1693785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693785600000",
    "number": "1184400459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1913 CARDIFF DR",
            "city": "PITTSBURG",
            "state": "CA",
            "postal_code": "945654049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1913 CARDIFF DR",
            "city": "PITTSBURG",
            "state": "CA",
            "postal_code": "945654049",
            "telephone_number": "925-267-9822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-04",
        "last_updated": "2023-09-04",
        "certification_date": "2023-09-03",
        "status": "A",
        "authorized_official_last_name": "DACE",
        "authorized_official_first_name": "GENEVIEVE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "925-623-6094",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ReVitalize Care Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karthik Reddy, MD
• Diamond Redus
• Taylor Reed
• Giovana Regalado, AMFT
• Renewing Roots Center
• Felipa Reyes, BA
• Maribel Esperanza Reyes, NP
• Olivia Reyes
• Jesse Thunderhawk Reyna, RADT
• Zeynab Rezapour

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Pittsburg, CA
• Providers in Pittsburg, CA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.