Revival Home Care

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

AL8758H Issued in AZ

Legal business name

REVIVAL HOME CARE

Practice address

8269 W State Ave
Glendale, AZ 85303

Phone

(602) 334-4187

Fax

(602) 334-4187

NPI assigned

Aug 29, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Fidelite Kankindi, MBR

Title

Caregiver

Phone

(623) 297-1305

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346198400000",
    "number": "1336498906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8269 W STATE AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85303",
            "telephone_number": "602-334-4187",
            "fax_number": "602-334-4187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8269 W STATE AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85303",
            "telephone_number": "602-334-4187",
            "fax_number": "602-334-4187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL HOME CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-29",
        "last_updated": "2012-08-29",
        "status": "A",
        "authorized_official_last_name": "KANKINDI",
        "authorized_official_first_name": "FIDELITE",
        "authorized_official_title_or_position": "CAREGIVER",
        "authorized_official_telephone_number": "623-297-1305",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBR"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "AZ",
            "license": "AL8758H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Behavioral Disturbances) in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Assisted Living Facility (Behavioral Disturbances) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.