OrganizationActive
Revita Life
NPI 1225139439 · Dietary Manager · Detroit, MI
Revita Life is a Dietary Manager organization in Detroit, MI (NPI 1225139439).
Provider details
- NPI number
- 1225139439
- Entity type
- Organization
- Primary specialty
- Dietary ManagerDietary & Nutritional Service Providers
- Organization subpart
- No
- Authorized official
- Andre Nunn, President(313) 745-7454
- License
- AN066667 (MI)
Specialties & taxonomies
Dietary & Nutritional Service Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4106 John R
Suite 805
Detroit, MI 48201
Phone: (313) 745-7454
Fax: (313) 993-8625
Street-level locationGet directions
Mailing address
4106 John R
Detroit, MI 48201
Registry dates
- Enumerated
- 2006-09-26
- Last updated
- 2020-08-22
Frequently asked questions
- What is Revita Life's NPI number?
- Revita Life's National Provider Identifier (NPI) is 1225139439, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Revita Life?
- Revita Life is classified in the NPPES registry as Dietary Manager (Dietary & Nutritional Service Providers).
- Where is Revita Life located?
- Revita Life's practice location on file with NPPES is 4106 John R, Detroit, MI 48201.
- What is Revita Life's phone number?
- The practice phone number listed in the NPPES registry for Revita Life is (313) 745-7454.
- Who is the authorized official for Revita Life?
- The authorized official listed on Revita Life's NPPES record is Andre Nunn, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Revita Life's NPI active?
- Yes — Revita Life's NPI (1225139439) is active in the NPPES registry as of the last update on 2020-08-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.