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General NPI Number Information
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NPI Number | 1255582300
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Entity Type | Organization
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Legal Business Name | REVOLUTION CARE, INC.
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 105 THATCHER CT
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City | NORTH WALES
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State | PA
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Zip | 19454-1226
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Country | US
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Telephone | 484-557-6980
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Fax | 215-997-6771
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Provider Business Mailing Address
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Address Line | 105 THATCHER CT
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City | NORTH WALES
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State | PA
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Zip | 19454-1226
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Country | US
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Telephone | 484-557-6980
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Fax | 215-997-6771
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN JOSEPH WHITMAN
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Credential |
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Telephone | 484-557-6980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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