NPI 1265012132

Revive Home Infusion Therapy LLC

Organisation Home Infusion Agency Winter Park, FL

Practice location

Address: 354 W Fairbanks Ave, Winter Park, FL 32789-5093
Phone: (321) 972-4243
Fax: (321) 972-4214

Authorised official

Name: Liliya Heretsun-Roussonicolos
Title: Owner
Phone: (772) 207-6266

Registered specialties

Home Infusion Agency Primary

Agencies Taxonomy 251F00000X

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Registry record

NPI: 1265012132
Entity type: Organization
NPI issued: 13 Apr 2021
Record last updated: 13 Apr 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.