Organization
REVIVAL HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FIDELITE KANKINDI MBR (CAREGIVER)
(623) 297-1305
Entity
Organization
Contact information
Practice address
8269 W STATE AVE, GLENDALE, AZ 85303
(602) 334-4187
(602) 334-4187
Mailing address
8269 W STATE AVE, GLENDALE, AZ 85303
(602) 334-4187
(602) 334-4187
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
AL8758H
AZ
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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