Provider Demographics
NPI:1205453867
Name:REVELATION ALF, CORP
Entity type:Organization
Organization Name:REVELATION ALF, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISBET
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-776-3105
Mailing Address - Street 1:8026 NW 162ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6110
Mailing Address - Country:US
Mailing Address - Phone:305-776-3105
Mailing Address - Fax:786-536-2806
Practice Address - Street 1:8026 NW 162ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6110
Practice Address - Country:US
Practice Address - Phone:305-776-3105
Practice Address - Fax:786-536-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility