Organization
REVIVED SENIOR LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL IWUJI (ADMINISTRATOR)
(704) 361-4187
Entity
Organization
Contact information
Practice address
7020 WILSON GROVE RD, MINT HILL, NC 28227-4352
(704) 361-4187
Mailing address
7020 WILSON GROVE RD, MINT HILL, NC 28227-4352
(704) 361-4187
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235885203
—
NC
Enumeration date
04/21/2022
Last updated
04/21/2022
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