Healthcare Provider Details

I. General information

NPI: 1366725673
Provider Name (Legal Business Name): REVOLUTIONARY NURSES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 SCRANTON CARBONDALE HIGHWAY
EYNON PA
18403
US

IV. Provider business mailing address

REVOLUTIONARY NURSES LLC 829 SCRANTON CARBONDALE HIGHWAY
EYNON PA
18403
US

V. Phone/Fax

Practice location:
  • Phone: 570-383-0825
  • Fax: 570-574-4225
Mailing address:
  • Phone: 570-383-0825
  • Fax: 570-574-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number16353601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number16353601
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number16353601
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number16353601
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number16353601
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number16353601
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number16353601
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number16353601
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number16353601
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number16353601
License Number StatePA
# 11
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number16353601
License Number StatePA
# 12
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number16353601
License Number StatePA
# 13
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number16353601
License Number StatePA
# 14
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number16353601
License Number StatePA
# 15
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number16353601
License Number StatePA

VIII. Authorized Official

Name: MS. ALEXIS DAWN SENNETT
Title or Position: ADMISTRATOR/HOME CARE
Credential:
Phone: 570-383-0825