Healthcare Provider Details

I. General information

NPI: 1720819485
Provider Name (Legal Business Name): REVAMP HOME HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 32ND ST APT 1506
CHICAGO IL
60616-4079
US

IV. Provider business mailing address

501 E 32ND ST APT 1506
CHICAGO IL
60616-4079
US

V. Phone/Fax

Practice location:
  • Phone: 312-459-2459
  • Fax:
Mailing address:
  • Phone: 312-459-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: VINCENT KING
Title or Position: ADMINISTRATOR
Credential:
Phone: 312-459-2459