Revival Home Health Care Agency Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

HCO08450 Issued in VA

Legal business name

REVIVAL HOME HEALTH CARE AGENCY INC

Doing business as

Revival Homecare Agency

Practice address

5101C Backlick Rd
Ste 2
Annandale, VA 22003-6061

Phone

(888) 225-6905

Fax

(888) 801-4714

NPI assigned

Jun 25, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Akram Elzend, PT, DPT, MBA&M

Title

President &Ceo

Phone

(888) 225-6905

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Revival Homecare Agency Doing business as
• Revival Home Health Care Agency Inc Former legal business name

Locations

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609200000000",
    "number": "1659577724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101C BACKLICK RD",
            "address_2": "STE 2",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220036061",
            "telephone_number": "888-225-6905",
            "fax_number": "888-801-4714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101C BACKLICK RD",
            "address_2": "STE 2",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220036061",
            "telephone_number": "888-225-6905",
            "fax_number": "888-801-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL HOME HEALTH CARE AGENCY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A",
        "authorized_official_last_name": "ELZEND",
        "authorized_official_first_name": "AKRAM",
        "authorized_official_title_or_position": "PRESIDENT &CEO",
        "authorized_official_telephone_number": "888-225-6905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, MBA&M"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "VA",
            "license": "HCO08450",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659577724",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revival Homecare Agency",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revival Homecare Agency",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revival Home Health Care Agency Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Home Health Agency in Annandale, VA
• Providers in Annandale, VA by specialty
• Home Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; 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.