NPIMap

Organization Active NPI

Revolutionary Home Health, Inc.

  • Home Health Agency
  • Eynon, PA
National Provider Identifier
1457359747
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
02590501 Issued in PA
Legal business name
REVOLUTIONARY HOME HEALTH, INC.
Practice address
829 Scranton Carbondale Hwy
Eynon, PA 18403-1020
Phone
(570) 383-7502
Fax
(570) 534-4225
NPI assigned
Jul 11, 2005
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Kathleen EvaninaNPI 1427024710
Title
Administrator
Phone
(570) 383-7502

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 02590501 PA Primary

Addresses

Primary practice location

829 Scranton Carbondale Hwy
Eynon, PA 18403-1020

Mailing address

829 Scranton Carbondale Hwy
Eynon, PA 18403-1020
Phone (570) 383-7502

Other identifiers 2

IdentifierTypeStateIssuer
1014816520001MedicaidPA
1795OtherPAGEISINGER HEALTH PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050606000918 PA Part A Provider - Home Health Agency 9830132331 Practice locations: Eynon, PA
O20140813000439 PA Part A Provider - Hospice 9830132331 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eynon, PA; Oreland, PA; Quakertown, PA
O20150309000392 PA Part A Provider - Home Health Agency 9830132331 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oreland, PA

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1457359747. Details of each certification follow.

Home health agency certification: CCN 398034

Legal name
REVOLUTIONARY HOME HEALTH, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 14, 2005
Last certification
Sep 14, 2012
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Aug 20, 2004 in PA
Enrollment address
829 Scranton Carbondale Hwy
Eynon, PA 18403-1020

Hospice certification: CCN 391764

Legal name
REVOLUTIONARY HOME HEALTH, INC.
Doing business as
REVOLUTIONARY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 21, 2014
Last certification
Aug 27, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Aug 20, 2004 in PA
Enrollment address
829 Scranton Carbondale Hwy
Eynon, PA 18403-1020

Home health agency certification: CCN 398241

Legal name
REVOLUTIONARY HOME HEALTH, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 3, 2015
Last certification
Aug 22, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Aug 20, 2014 in PA
Enrollment address
110 Pennsylvania Ave
Ste 200
Oreland, PA 19075

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Revolutionary Home Health IncCCN 398034 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Oct 14, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Care Compare: Home health agency

Medicare Care Compare
Listed as
Revolutionary Home Health Inc.CCN 398241 · All quality measures
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Nov 3, 2015
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Care Compare: Hospice

Medicare Care Compare
Listed as
Revolutionary HospiceCCN 391764 · All quality measures
Ownership
For-Profit
Certified
Oct 21, 2014
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

110 Pennsylvania Ave
Oreland, PA 19075
Phone (215) 600-3360

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jennifer Lynn Feldra Individual 5% Or Greater Direct Ownership InterestCfo Aug 20, 2004 50%
Corporate OfficerCfo Aug 20, 2004 50%
Corporate DirectorBoard Member Aug 20, 2004 50%
W-2 Managing EmployeeCfo Aug 20, 2004 50%
Operational/Managerial ControlCfo Aug 20, 2004 50%
OtherBoard Member Aug 20, 2004 50%
5% Or Greater Direct Ownership Interest Aug 20, 2004 50%
Corporate OfficerCfo, Board Member, Director Aug 20, 2004
Corporate DirectorCfo, Board Member Aug 20, 2004
W-2 Managing EmployeeCfo Aug 20, 2004
Operational/Managerial ControlCfo Aug 20, 2004
Kathleen M Evanina Individual 5% Or Greater Direct Ownership InterestCeo Aug 20, 2004 50%
Corporate OfficerCeo Aug 20, 2004 50%
Corporate DirectorBoard Member Aug 20, 2004
5% Or Greater Direct Ownership InterestAdministrator Aug 20, 2004 50%
Corporate DirectorBoard Member Aug 20, 2004 50%
W-2 Managing EmployeeAdministrator Aug 20, 2004 50%
Operational/Managerial ControlAdministrator Aug 20, 2004 50%
OtherBoard Member Aug 20, 2004 50%
5% Or Greater Direct Ownership Interest Aug 20, 2004 50%
Corporate OfficerCeo, President Aug 20, 2004
Corporate DirectorCeo, Administrator, President, B Aug 20, 2004
W-2 Managing EmployeeCeo Aug 20, 2004
Operational/Managerial ControlAdministrator, Ceo Aug 20, 2004
Kokpar Wohwoh Individual W-2 Managing EmployeeAd; May 14, 2026 10%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Kathleen Evanina, NP
    • Nurse Practitioner
    • Eynon, PA
    • NPI 1427024710

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control, Other, W-2 Managing Employee

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 28

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1457359747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 SCRANTON CARBONDALE HWY",
            "city": "EYNON",
            "state": "PA",
            "postal_code": "184031020",
            "telephone_number": "570-383-7502",
            "fax_number": "866-600-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 SCRANTON CARBONDALE HWY",
            "city": "EYNON",
            "state": "PA",
            "postal_code": "184031020",
            "telephone_number": "570-383-7502",
            "fax_number": "570-534-4225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTIONARY HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-11",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "EVANINA",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "570-383-7502"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "02590501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014816520001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "1795",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eynon, PA

Sources for this page

Verify at the official NPI Registry.