Provider Demographics
NPI:1881228831
Name:REVITALITY LLC
Entity Type:Organization
Organization Name:REVITALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AVVINASH
Authorized Official - Middle Name:
Authorized Official - Last Name:RADAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-557-4000
Mailing Address - Street 1:6 ANTHONY CIR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-4215
Mailing Address - Country:US
Mailing Address - Phone:603-557-4000
Mailing Address - Fax:
Practice Address - Street 1:6 ANTHONY CIR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-4215
Practice Address - Country:US
Practice Address - Phone:603-557-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies