Provider Demographics
NPI:1033838941
Name:REVOLUTIONARY CARE LLC
Entity Type:Organization
Organization Name:REVOLUTIONARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TITILAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIMOGUNJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-421-3602
Mailing Address - Street 1:14311 DRIFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3042
Mailing Address - Country:US
Mailing Address - Phone:240-421-3602
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW STE 3000
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2969
Practice Address - Country:US
Practice Address - Phone:240-421-3602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center