Revamp Wellness Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

REVAMP WELLNESS CENTER

Practice address

410 E Southern Ave
Tempe, AZ 85282-5212

Phone

(480) 747-4623

NPI assigned

Mar 10, 2023

Last updated

May 22, 2023By 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

Phillis Chepkorir Mutembete, NPNPI 1215230081

Title

Owner

Phone

(480) 747-4623

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Phillis Mutembete, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Tempe, AZ
  • NPI 1215230081
  NPD Authorized official

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

{
    "created_epoch": "1678406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1740981380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E SOUTHERN AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852825212",
            "telephone_number": "480-747-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E SOUTHERN AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852825212",
            "telephone_number": "480-747-4623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVAMP WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-10",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A",
        "authorized_official_last_name": "MUTEMBETE",
        "authorized_official_first_name": "PHILLIS",
        "authorized_official_middle_name": "CHEPKORIR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-747-4623",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Tempe, AZ
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.