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General NPI Number Information
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NPI Number | 1245750041
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Entity Type | Organization
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Legal Business Name | REVELATION HOME HEALTH CARE
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 06/22/2017
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Provider Practice Location Address
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Address Line | 331 E. MAIN STREET
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City | ROCK HILL
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State | SC
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Zip | 29730
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Country | US
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Telephone | 803-909-9358
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Fax |
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Provider Business Mailing Address
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Address Line | 6904 PLEASANT GROVE RD
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City | CHARLOTTE
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State | NC
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Zip | 28216-1319
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Country | US
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Telephone | 202-567-9628
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MAURICE YOUNG
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Credential |
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Telephone | 202-567-9628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | SC
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