Provider Demographics
NPI:1598774754
Name:REVITAL CARE HOSPICE, INC.
Entity Type:Organization
Organization Name:REVITAL CARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-484-8254
Mailing Address - Street 1:711 N ALVARADO ST STE 108
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4016
Mailing Address - Country:US
Mailing Address - Phone:213-484-8254
Mailing Address - Fax:213-484-8265
Practice Address - Street 1:711 N ALVARADO ST STE 108
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4016
Practice Address - Country:US
Practice Address - Phone:213-484-8254
Practice Address - Fax:213-484-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient