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General NPI Number Information
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NPI Number | 1700711306
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Entity Type | Organization
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Legal Business Name | REVORA HEALTH SYSTEMS
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Dates
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Enumeration Date | 06/15/2026
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Last Update Date | 06/15/2026
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Provider Practice Location Address
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Address Line | 550 VIGOR WAY STE 102
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City | ROCKWALL
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State | TX
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Zip | 75087-5348
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Country | US
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Telephone | 202-907-6714
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Fax |
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Provider Business Mailing Address
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Address Line | 550 VIGOR WAY
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City | ROCKWALL
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State | TX
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Zip | 75087-5347
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHIDI MARTINS
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Credential | MD
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Telephone | 202-907-6714
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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 |
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