| Revolutionary Care Llc | |
|
106 Irving St Nw Ste 3000 Washington DC 20010-2969 | |
| (240) 421-3602 | |
| Not Available |
| Full Name | Revolutionary Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 106 Irving St Nw Ste 3000, Washington, District Of Columbia |
| Authorized Official Name and Position | Titilayo Orimogunje (PRESIDENT) |
| Authorized Official Contact | 2404213602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolutionary Care Llc 14311 Driftwood Rd Bowie MD 20721-3042 Ph: (240) 421-3602 | Revolutionary Care Llc 106 Irving St Nw Ste 3000 Washington DC 20010-2969 Ph: (240) 421-3602 |
| NPI Number | 1033838941 |
|---|---|
| Provider Enumeration Date | 08/24/2022 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 1658749841 |
|---|---|
| Medicare Enrollment ID | O20221118001485 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033838941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Titilayo O Orimogunje |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932447109 PECOS PAC ID: 9032347414 Enrollment ID: I20140109001207 |
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