Provider Demographics
NPI:1649427030
Name:REVIVAL HEALTH CARE SERVICES ,INC
Entity type:Organization
Organization Name:REVIVAL HEALTH CARE SERVICES ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUKEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-845-3181
Mailing Address - Street 1:5952 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8513
Mailing Address - Country:US
Mailing Address - Phone:817-845-3181
Mailing Address - Fax:817-608-0505
Practice Address - Street 1:5952 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8513
Practice Address - Country:US
Practice Address - Phone:817-845-3181
Practice Address - Fax:817-608-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management