Organization

Life Revival Llc

Legal Business Name

Life Revival Llc

NPI Number

1023701067

NPI Type

Organization

Enumeration Date

05/26/2023

Contact
Information

Purpose

Mailing
Location

Address

6404 ROOSEVELT BLVD
6404 ROOSEVELT BLVD

City

Philadelphia
Philadelphia

State

PA
PA

Postal Code

19149-2943
19149-2943

Country

US
US

Telephone Number

N/A
(267) 577-7747

Authorized Official

Name

Dr. Daniel Lee

Title or Position

DIRECTOR

Telephone Number

(267) 259-4558

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 05/26/2023

Provider Address