Revita Healthcare, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1011579 Issued in IL

Legal business name

REVITA HEALTHCARE, LLC

Practice address

120 W Golf Rd Ste 210
Schaumburg, IL 60195-5161

Phone

(847) 380-6253

Fax

(847) 947-2786

NPI assigned

Sep 29, 2012

Last updated

Sep 29, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Consuelo Lagasca Dumayas

Title

Administrator

Phone

(847) 380-6253

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348876800000",
    "number": "1093066045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W GOLF RD STE 210",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601955161",
            "telephone_number": "847-380-6253",
            "fax_number": "847-947-2786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W GOLF RD STE 210",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601955161",
            "telephone_number": "847-380-6253",
            "fax_number": "847-947-2786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITA HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-29",
        "last_updated": "2012-09-29",
        "status": "A",
        "authorized_official_last_name": "DUMAYAS",
        "authorized_official_first_name": "CONSUELO",
        "authorized_official_middle_name": "LAGASCA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "847-380-6253",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.