Organization
REVIVAL HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE BENITO M.D. (OWNER)
(305) 887-0808
Entity
Organization
Contact information
Practice address
68 W 7TH ST, HIALEAH, FL 33010-4308
(305) 887-0808
(305) 887-3996
Mailing address
68 W 7TH ST, HIALEAH, FL 33010-4308
(305) 887-0808
(305) 887-3996
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL9109
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140707100
—
FL
Enumeration date
04/24/2008
Last updated
04/24/2008
Update your record
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