Revival Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL9109 Issued in FL

Legal business name

REVIVAL HOME

Practice address

68 W 7TH St
Hialeah, FL 33010-4308

Phone

(305) 887-0808

Fax

(305) 887-3996

NPI assigned

Apr 24, 2008

Organization subpart

No

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

Authorized official

Name

Jorge Benito, M.D.

Title

Owner

Phone

(305) 887-0808

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1700051489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 W 7TH ST",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330104308",
            "telephone_number": "305-887-0808",
            "fax_number": "305-887-3996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 W 7TH ST",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330104308",
            "telephone_number": "305-887-0808",
            "fax_number": "305-887-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-24",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "BENITO",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-887-0808",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL9109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140707100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Hialeah, FL
• Providers in Hialeah, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.