Provider Demographics
NPI:1972007128
Name:REVITALIZE HEALTHCARE, INC
Entity Type:Organization
Organization Name:REVITALIZE HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BABENCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-556-1630
Mailing Address - Street 1:657 LONE OAK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4547
Mailing Address - Country:US
Mailing Address - Phone:270-556-1630
Mailing Address - Fax:
Practice Address - Street 1:657 LONE OAK RD STE 2
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4547
Practice Address - Country:US
Practice Address - Phone:270-556-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty