NPIMap

Organization Active NPI

Revive Home Care Inc.

  • Home Health Agency
  • El Paso, TX
National Provider Identifier
1487735346
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
009990 Issued in TX
Legal business name
REVIVE HOME CARE INC.
Practice address
1852 Dale Douglas Dr Ste B
El Paso, TX 79936-4251
Phone
(915) 203-1068
Fax
(915) 772-1303
NPI assigned
Oct 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Authorized official

Name
Martha Hapgood
Title
Administrator
Phone
(915) 772-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 009990 TX Primary

Addresses

Primary practice location

1852 Dale Douglas Dr Ste B
El Paso, TX 79936-4251

Mailing address

1852 Dale Douglas Dr Ste B
El Paso, TX 79936-4251
Phone (915) 772-1300

Other identifiers 1

IdentifierTypeStateIssuer
180102901MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050915001175 TX Part A Provider - Home Health Agency 3072546399 Practice locations: El Paso, TX

Home health agency certification: CCN 677916

Legal name
REVIVE HOME CARE INC.
Doing business as
REVIVE HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 6, 2006
Last certification
Sep 24, 2020
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
May 27, 2005 in TX
Enrollment address
1852 Dale Douglas Dr
Ste B
El Paso, TX 79936-4251

Care Compare: Home health agency

Medicare Care Compare
Listed as
Revive Home Care IncCCN 677916
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Apr 6, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Revive Home Care Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1393 George Dieter Dr
Ste B
El Paso, TX 79936
Phone (915) 702-0165

1852 Dale Douglas Dr
Ste B
El Paso, TX 79936
Phone (915) 203-1068

1160 Airway Blvd
Ste D3-2
El Paso, TX 79925
Phone (915) 772-1300

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jay Dirkx Individual 5% Or Greater Direct Ownership Interest May 27, 2005 50%
Corporate Director Sep 15, 2005 50%
W-2 Managing Employee Jan 4, 2012 50%
Martha Hapgood Individual 5% Or Greater Direct Ownership Interest May 27, 2005 50%
Corporate Officer Jan 4, 2012 50%
Corporate Director Sep 15, 2005 50%
W-2 Managing Employee May 27, 2005 50%

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1487735346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1852 DALE DOUGLAS DR STE B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799364251",
            "telephone_number": "915-772-1300",
            "fax_number": "915-772-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1852 DALE DOUGLAS DR STE B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799364251",
            "telephone_number": "915-203-1068",
            "fax_number": "915-772-1303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HOME CARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "HAPGOOD",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "915-772-1300"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "009990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180102901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.