Provider Demographics
NPI:1699220236
Name:REVISION
Entity Type:Organization
Organization Name:REVISION
Other - Org Name:REVISION COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE CHAIR, BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:SANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-206-7754
Mailing Address - Street 1:136 S IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3943
Mailing Address - Country:US
Mailing Address - Phone:714-602-8855
Mailing Address - Fax:
Practice Address - Street 1:136 S IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3943
Practice Address - Country:US
Practice Address - Phone:714-602-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health