Organization
REVOLUTION HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID GRILLO (MANAGING MEMBER)
(310) 994-6411
Entity
Organization
Contact information
Practice address
4300 N DECATUR BLVD, LAS VEGAS, NV 89130
(702) 655-2101
Mailing address
7570 NORMAN ROCKWELL LN STE 140, LAS VEGAS, NV 89143-6012
(702) 656-3264
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
07/02/2018
Last updated
07/05/2018
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