| Entity Name: | REVIVAL HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 May 1997 (28 years ago) |
| Document Number: | P97000048316 |
| FEI/EIN Number | 650798674 |
| Address: | 15850 SW 141 TERRACE, MIAMI, FL, 33196, US |
| Mail Address: | 15850 SW 141 TERRACE, MIAMI, FL, 33196, US |
| ZIP code: | 33196 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700051489 | 2008-04-24 | 2008-04-24 | 68 W 7TH ST, HIALEAH, FL, 330104308, US | 68 W 7TH ST, HIALEAH, FL, 330104308, US | |||||||||||||||||||||||||
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| Phone | +1 305-887-0808 |
| Fax | 3058873996 |
Authorized person
| Name | JORGE BENITO |
| Role | OWNER |
| Phone | 3058870808 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL9109 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 140707100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALEMAN ZOILA | Agent | 15850 SW 141 TERRACE, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| ALEMAN ZOILA | President | 15850 SW 141 TERRACE, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| ALEMAN GUILLERMO | Vice President | 15850 SW 141 TERRACE, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| SUAREZ JANET L | Secretary | 15850 SW 141 TERRACE, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| ALEMAN ALEJANDRO | Treasurer | 15850 SW 141 TERRACE, MIAMI, FL, 33196 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| AMENDMENT | 2013-06-28 | No data | No data |
| REINSTATEMENT | 2002-05-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2001-06-05 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
