# REVOLUTION HEALTH CENTER

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

## Provider details

- **NPI number:** 1710473772
- **Authorized official:** MR. DAVID GRILLO (MANAGING MEMBER)
- **Authorized official phone:** (310) 994-6411

## Contact information

- **Practice address:** 4300 N DECATUR BLVD, LAS VEGAS, NV 89130
- **Practice address phone:** (702) 655-2101
- **Mailing address:** 7570 NORMAN ROCKWELL LN STE 140, LAS VEGAS, NV 89143-6012
- **Mailing address phone:** (702) 656-3264

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 103TC1900X | Counseling Psychologist | — | NULL | — |
| 103TC1900X | Counseling Psychologist | — | — | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 07/02/2018
- **Last updated:** 07/05/2018