Organization
REVOLUTION ACCESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY ANN RUSSELL (SENIOR DIRECTOR)
(629) 252-8211
Entity
Organization
Contact information
Practice address
85 SHILOH ROAD, UNIT 50, ASHEVILLE, NC 28803
(828) 417-3285
(828) 417-3289
Mailing address
9495 WINNETKA AVE N STE 200, BROOKLYN PARK, MN 55445-1618
(629) 252-8211
(763) 255-3972
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
171WH0202X
Home Modifications Contractor
—
—
171WV0202X
Vehicle Modifications Contractor
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
08/28/2019
Last updated
04/17/2024
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