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General NPI Number Information
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NPI Number | 1154653475
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Entity Type | Organization
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Legal Business Name | REVOLUTIONARY HOME HEALTH INC
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1541 N WEST END BLVD
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City | QUAKERTOWN
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State | PA
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Zip | 18951-4122
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Country | US
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Telephone | 484-244-4827
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Fax | 484-244-4925
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Provider Business Mailing Address
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Address Line | 829 SCRANTON CARBONDALE HWY
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City | EYNON
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State | PA
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Zip | 18403-1020
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Country | US
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Telephone | 570-383-7502
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KATHLEEN EVANINA
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Credential | CRNP
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Telephone | 484-244-4827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 04090501
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License Number State | PA
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