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21D2139244 CLIA NUMBER - REVIVAL HOME CARE

Laboratory Demographics

CLIA Number: 21D2139244

Facility Name: REVIVAL HOME CARE

Facility Address:
1101 MERCANTILE LANE SUITE 292
UPPER MARLBORO, MD
ZIP 20774
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Facility Phone Number: (301) 899-6070

Facility Type: HOME HEALTH AGENCY

Certificate Type: Waiver
NPI Number: 1811194061

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 21D2139244
LAB Type HOME HEALTH AGENCY
Facility Name REVIVAL HOME CARE
Street 1101 MERCANTILE LANE SUITE 292
City UPPER MARLBORO
State MD
ZIP 20774
Phone (301) 899-6070

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This page was last updated on: 5/11/2023