Provider Demographics
NPI:1073958922
Name:REVIVAL HOMECARE OF DALLAS, INC.
Entity Type:Organization
Organization Name:REVIVAL HOMECARE OF DALLAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHORNAYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:347-302-3425
Mailing Address - Street 1:251 E 5TH ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2403
Mailing Address - Country:US
Mailing Address - Phone:718-338-6300
Mailing Address - Fax:
Practice Address - Street 1:9330 LBJ FWY
Practice Address - Street 2:SUIT 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3436
Practice Address - Country:US
Practice Address - Phone:171-833-8630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health