| Life Revival Llc | |
|
6404 Roosevelt Blvd Philadelphia PA 19149-2943 | |
| (267) 577-7747 | |
| Not Available |
| Full Name | Life Revival Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6404 Roosevelt Blvd, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Daniel Lee (DIRECTOR) |
| Authorized Official Contact | 2672594558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Revival Llc 6404 Roosevelt Blvd Philadelphia PA 19149-2943 Ph: () - | Life Revival Llc 6404 Roosevelt Blvd Philadelphia PA 19149-2943 Ph: (267) 577-7747 |
| NPI Number | 1023701067 |
|---|---|
| Provider Enumeration Date | 05/26/2023 |
| Last Update Date | 05/26/2023 |
| Certification Date | 05/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023701067 | NPI | - | NPPES |
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