Provider Demographics
NPI:1457359747
Name:REVOLUTIONARY HOME HEALTH, INC.
Entity Type:Organization
Organization Name:REVOLUTIONARY HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-383-7502
Mailing Address - Street 1:829 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1020
Mailing Address - Country:US
Mailing Address - Phone:570-383-7502
Mailing Address - Fax:866-600-7413
Practice Address - Street 1:829 SCRANTON CARBONDALE HWY
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1020
Practice Address - Country:US
Practice Address - Phone:570-383-7502
Practice Address - Fax:570-534-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02590501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1795OtherGEISINGER HEALTH PLAN
PA1014816520001Medicaid
PA1014816520001Medicaid
PA398034Medicare ID - Type Unspecified