1. Home
  2. Directory
  3. Washington
  4. Kennewick
  5. Custodial Care Facility
  6. NPI Profile

REVIVAL ADULT FAMILY HOME LLC
NPI 1578350104
Custodial Care Facility - Adult Care Home in Kennewick, WA

Active since April 25, 2025CLIA 50D2332818 · Waiver
207 W 31ST AVE, KENNEWICK, WA 99337(509) 508-6833(509) 987-1755 Get Directions Write a Review

NPPES record last updated: April 25, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Revival Adult Family Home Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

REVIVAL ADULT FAMILY HOME LLC (NPI 1578350104) is a healthcare organization registered as an adult care home in Kennewick, Washington and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists Timothy Mushira, Afh Provider, as its authorized official.

NPPES Registry Identity

NPI1578350104
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameREVIVAL ADULT FAMILY HOME LLC
Location Address207 W 31ST AVEKennewick, WA 99337-5023
Mailing Address207 W 31st AveKennewick, WA 99337-5023 · (509) 508-6833 · Fax (509) 987-1755
Phone(509) 508-6833
Fax(509) 987-1755
Organization SubpartNo
Authorized OfficialTimothy MushiraAfh Provider · (509) 508-6833
Enumeration DateApril 25, 2025
NPPES CertifiedApril 24, 2025
✔ NPI 1578350104 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
207 W 31ST AVE, Kennewick, WA 99337
Open in Google Maps ↗

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2332818

Revival Adult Family Home LLC · Kennewick, WA
Active · expires Apr 4, 2028
CLIA Number50D2332818
Laboratory TypeAfh
Certificate Effective DateOctober 24, 2025
Certificate Expiration DateApril 4, 2028
Laboratory DirectorTimothy Mushira
Laboratory Phone(509) 987-1755
Laboratory LocationRevival Adult Family Home LLC207 W 31st Ave, Kennewick, WA 99337
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revival Adult Family Home LLC's NPI number?

The NPI number for Revival Adult Family Home LLC is 1578350104. It was assigned to this organization in the NPPES registry on April 25, 2025.

Where is Revival Adult Family Home LLC located?

Revival Adult Family Home LLC is located at 207 W 31st Ave, Kennewick, WA 99337. The listed phone number is (509) 508-6833.

What is Revival Adult Family Home LLC's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Does Revival Adult Family Home LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2332818) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Revival Adult Family Home LLC was last updated on April 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.