Provider Demographics
NPI:1043696651
Name:REVLIFE LLC
Entity type:Organization
Organization Name:REVLIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-658-7134
Mailing Address - Street 1:4202 INVERRARY BLVD APT 75B
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4137
Mailing Address - Country:US
Mailing Address - Phone:954-658-7134
Mailing Address - Fax:954-530-5894
Practice Address - Street 1:4202 INVERRARY BLVD APT 75B
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4137
Practice Address - Country:US
Practice Address - Phone:954-658-7134
Practice Address - Fax:954-530-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office BasedGroup - Multi-Specialty