MEDICARE: REVAMP HOME HEALTHCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1720819485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVAMP HOME HEALTHCARE INC

Provider Business Mailing Address
First Line	:	501 E 32ND ST APT 1506
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4079
Country	:	US
Telephone Number	:	312-459-2459
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 E 32ND ST APT 1506
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4079
Country	:	US
Telephone Number	:	312-459-2459
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VINCENT KING
Credential	:
Telephone Number	:	312-459-2459

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	04/22/2026

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