Provider Demographics
NPI:1609180108
Name:REVOLUTION HEALTH SYSTEMS
Entity Type:Organization
Organization Name:REVOLUTION HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:VANTIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-728-1957
Mailing Address - Street 1:1050 BROADWAY STE 6
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2173
Mailing Address - Country:US
Mailing Address - Phone:219-728-1957
Mailing Address - Fax:219-926-3400
Practice Address - Street 1:2214 E 70TH ST
Practice Address - Street 2:SUITE 2N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1714
Practice Address - Country:US
Practice Address - Phone:219-728-1957
Practice Address - Fax:219-926-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17729-74848332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies