# REVIVED SENIOR LIVING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811631336
- **Authorized official:** DANIEL IWUJI (ADMINISTRATOR)
- **Authorized official phone:** (704) 361-4187

## Contact information

- **Practice address:** 7020 WILSON GROVE RD, MINT HILL, NC 28227-4352
- **Practice address phone:** (704) 361-4187
- **Mailing address:** 7020 WILSON GROVE RD, MINT HILL, NC 28227-4352
- **Mailing address phone:** (704) 361-4187

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/21/2022
- **Last updated:** 04/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1235885203 | — | NC |