Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revita Life

Organization Dietary Manager · NPI 1225139439

Revita Life is a Dietary Manager in Detroit, Michigan. Licensed in Michigan. Registered with an NPI since 2006.

Licensed in
MI
In the registry since
2006

Practice location Address checks out

4106 John R Ste 805
Detroit, MI 48201
Phone: (313) 745-7454
Fax: (313) 993-8625
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dietary Manager (primary) Taxonomy 132700000X · Licence AN066667 (MI)

Record details

NPI number1225139439
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Andre Nunn — President · (313) 745-7454
NPI enumeratedSeptember 26, 2006
Last updated in NPPESAugust 22, 2020
Mailing address4106 John R, Suite 805, Detroit, MI 48201

Other providers in Detroit