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General NPI Number Information
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NPI Number | 1033838941
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Entity Type | Organization
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Legal Business Name | REVOLUTIONARY CARE LLC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 106 IRVING ST NW STE 3000
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City | WASHINGTON
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State | DC
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Zip | 20010-2969
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Country | US
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Telephone | 240-421-3602
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Fax |
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Provider Business Mailing Address
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Address Line | 14311 DRIFTWOOD RD
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City | BOWIE
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State | MD
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Zip | 20721-3042
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Country | US
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Telephone | 240-421-3602
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TITILAYO ORIMOGUNJE
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Credential |
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Telephone | 240-421-3602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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