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General NPI Number Information
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NPI Number | 1417041534
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Entity Type | Organization
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Legal Business Name | REVOLUTIONARY HOME HEALTH
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 219 SE 23RD AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7619
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Country | US
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Telephone | 561-296-2770
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Fax | 561-296-2771
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Provider Business Mailing Address
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Address Line | 219 SE 23RD AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7619
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Country | US
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Telephone | 561-296-2770
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Fax | 561-296-2771
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. DEBRA LEE II
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Credential | R.N.
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Telephone | 561-296-2770
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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 | 299992118
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License Number State | FL
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