# REVOLUTIONARY HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053930107
- **Authorized official:** WIKENSON JESTINE (MANAGER)
- **Authorized official phone:** (561) 713-4819

## Contact information

- **Practice address:** 3175 S CONGRESS AVE STE 203, PALM SPRINGS, FL 33461-2562
- **Practice address phone:** (561) 328-7527
- **Mailing address:** 3175 S CONGRESS AVE STE 203, PALM SPRINGS, FL 33461-2562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/09/2020
- **Last updated:** 04/09/2020