Organization
REVITAL HEALTH CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMANUEL NDE PHARMD (OFFICER)
(571) 365-1833
Entity
Organization
Contact information
Practice address
1629 K ST NW STE 300NW, WASHINGTON, DC 20006-1602
(571) 365-1833
Mailing address
1629 K ST NW STE 300NW, WASHINGTON, DC 20006-1602
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Enumeration date
10/31/2024
Last updated
10/31/2024
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