Organization
REVIVAL ADULT FAMILY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MUSHIRA (AFH PROVIDER)
(509) 508-6833
Entity
Organization
Contact information
Practice address
207 W 31ST AVE, KENNEWICK, WA 99337-5023
(509) 508-6833
(509) 987-1755
Mailing address
207 W 31ST AVE, KENNEWICK, WA 99337-5023
(509) 508-6833
(509) 987-1755
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
04/25/2025
Last updated
04/25/2025
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