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Organization
REVAMP REHAB, LLC
Active
Organization
REVAMP REHAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EKENE AJUFO M.D (OWNER)
(352) 620-5211
Entity
Organization
Contact information
Practice address
2131 SW 22ND PL STE 100, OCALA, FL 34471-7759
(352) 620-5211
Mailing address
1522 W 23RD ST, HOUSTON, TX 77008-1509
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
08/28/2023
Last updated
04/13/2024
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