Revive Home Infusion Therapy LLC

Primary specialty

Home Infusion AgencyTaxonomy code 251F00000X

Legal business name

REVIVE HOME INFUSION THERAPY LLC

Practice address

354 W Fairbanks Ave
Winter Park, FL 32789-5093

Phone

(321) 972-4243

Fax

(321) 972-4214

NPI assigned

Apr 13, 2021

Organization subpart

No

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

Authorized official

Name

Liliya Heretsun-RoussonicolosNPI 1407464506

Title

Owner

Phone

(772) 207-6266

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Liliya Heretsun-Roussonicolos

  • Durable Medical Equipment & Medical Supplies
  • Port St Lucie, FL
  • NPI 1407464506
  NPD Authorized official

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

{
    "created_epoch": "1618272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1265012132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "354 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895093",
            "telephone_number": "321-972-4243",
            "fax_number": "321-972-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 W FAIRBANKS AVE",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895093",
            "telephone_number": "321-972-4243",
            "fax_number": "321-972-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HOME INFUSION THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-13",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "HERETSUN-ROUSSONICOLOS",
        "authorized_official_first_name": "LILIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "772-207-6266"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cade Jarrod Resnick, LMFT
• Christopher Resnik, DMD, MDS
• Resonance Acupuncture & Holistic Health Solution LLC
• Rethink Health Direct Primary Care, LLC
• Alyssa M Reuscher, R.M.H.C.I., M.A.
• Azalia Michelle Reyes Ramos
• Ana Gabriella Reyes, DNP, APRN, AGACNP-BC
• Desiree Reynolds, MSN-ED, APRN-C
• Dynvar Reynolds
• George M Reynolds, A.P.

• Home Infusion Agency in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Home Infusion Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; 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.