Revelry Wellness, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

REVELRY WELLNESS, LLC

Practice address

7125 Orchard Lake Rd Ste 210
West Bloomfield, MI 48322-3618

Phone

(866) 469-1033

NPI assigned

Feb 15, 2022

Last updated

Feb 15, 2022By 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

Dmitry Turbovsky

Title

Administrator

Phone

(866) 469-1033

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644883200000",
    "number": "1659026037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7125 ORCHARD LAKE RD STE 210",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223618",
            "telephone_number": "866-469-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7125 ORCHARD LAKE RD STE 210",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483223618",
            "telephone_number": "866-469-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVELRY WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-15",
        "last_updated": "2022-02-15",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "TURBOVSKY",
        "authorized_official_first_name": "DMITRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "866-469-1033"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "support@revelrywellness.com",
            "affiliation": "N",
            "address_1": "7125 Orchard Lake Rd Ste 210",
            "city": "West Bloomfield",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483223618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Multi-Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; 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.