Provider Demographics
NPI:1386025914
Name:REVERE HEALTHCARE SOLUTIONS, INC
Entity Type:Organization
Organization Name:REVERE HEALTHCARE SOLUTIONS, INC
Other - Org Name:RHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-283-8223
Mailing Address - Street 1:4121 W 83RD ST
Mailing Address - Street 2:SUITE 151
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5472
Mailing Address - Country:US
Mailing Address - Phone:913-283-8223
Mailing Address - Fax:
Practice Address - Street 1:302 FLEMING ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5972
Practice Address - Country:US
Practice Address - Phone:620-271-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7918758261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center