33D1052821 CLIA NUMBER - REVIVAL HOME HEALTH CARE

Laboratory Demographics

CLIA Number: 33D1052821

Facility Name: REVIVAL HOME HEALTH CARE

Facility Address:
5350 KINGS HIGHWAY
BROOKLYN, NY
ZIP 11203
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Facility Phone Number: 718 629-1000

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1841233178

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	33D1052821
LAB Type	Home Health Agency
Facility Name	REVIVAL HOME HEALTH CARE
Street	5350 KINGS HIGHWAY
City	BROOKLYN
State	NY
ZIP	11203
Phone	718 629-1000
CertificateType	4
CertificateEffectiveDate	8/23/2018
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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This page was last updated on: 4/23/2024