Organization
REVIZION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN MARTIN (CO OWNER)
(704) 405-6668
Entity
Organization
Contact information
Practice address
543 COX RD, GASTONIA, NC 28054-0607
(704) 405-6668
Mailing address
543 COX RD STE D7, GASTONIA, NC 28054-0607
(704) 405-6668
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
385H00000X
Respite Care
Primary
—
—
Other
Enumeration date
03/25/2021
Last updated
04/05/2021
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