Revolution Health Center

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

REVOLUTION HEALTH CENTER

Practice address

4300 N Decatur Blvd
Las Vegas, NV 89130

Phone

(702) 655-2101

NPI assigned

Jul 2, 2018

Organization subpart

No

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

Authorized official

Name

Mr. David Grillo

Title

Managing Member

Phone

(310) 994-6411

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530748800000",
    "number": "1710473772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7570 NORMAN ROCKWELL LN STE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891436012",
            "telephone_number": "702-656-3264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 N DECATUR BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89130",
            "telephone_number": "702-655-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-02",
        "last_updated": "2018-07-05",
        "status": "A",
        "authorized_official_last_name": "GRILLO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "310-994-6411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; 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.