JOHNNA REVIS (NPI# 1205202413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205202413 |
| Entity Type | Individual |
| Full Name | JOHNNA REVIS |
| Credential | PTA |
| Practice Address |
5768 Highway 14 Gray Court SC 29645-6764 |
| Practice Telephone | 8648722116 |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2015-08-12 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320700000X | Residential Treatment Facility, Physical Disabilities | 1771 | SC | Residential Treatment Facilities |
| Street Address |
5768 HIGHWAY 14 |
| City | GRAY COURT |
| State | SC |
| Zip Code | 29645-6764 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740788066 | Zivitski Health Group LLC | Pharmacy | 345 W Main Street, Gray Court, SC 29645 | 2018-02-01 |
| 1053756072 | Joan Williams Greene | Speech-Language Pathologist | 9210 Hwy 14, Gray Court, SC 29645 | 2013-05-03 |
| 1215064571 | Gray Court Pharmacy | Pharmacy | 345 West Main St, Gray Court, SC 29645 | 2007-02-27 |
| 1871192674 | Mlc Homecare LLC | In Home Supportive Care | 363 W Main St, Gray Court, SC 29645 | 2020-10-22 |
| 1346622883 | Nathanael Ricardo Benitez | Family Medicine | 9100 Highway 14, Gray Court, SC 29645 | 2015-06-21 |
| 1518498336 | Spartanburg Medical Center | Family Medicine | 2846 N Old Laurens Rd, Gray Court, SC 29645-3157 | 2017-03-23 |
| 1356745277 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 9032 Highway 14, Gray Court, SC 29645-4151 | 2014-10-21 |
| 1558305029 | Christopher Todd Nelson | Family Medicine | 9100 Highway 14, Gray Court, SC 29645-4152 | 2006-06-15 |
| 1396306478 | Brittany Edge Thomas | Nurse Practitioner | 9100 Highway 14, Gray Court, SC 29645-4152 | 2019-06-27 |
| 1700239787 | Prisma Health-upstate | Clinic/Center | 9100 Highway 14, Gray Court, SC 29645-4152 | 2016-07-14 |
| Find all providers in zip 29645 | ||||
| Taxonomy Code | 320700000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Physical Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417497314 | Wayne Chavis | Residential Treatment Facility, Physical Disabilities | 7223 Kendallwood Ct, Fort Mill, SC 29715-6219 | 2017-02-27 |
| 1336588243 | Serenity Manor | Residential Treatment Facility, Physical Disabilities | 4018 S Rhett Ave, N Charleston, SC 29405-7163 | 2013-06-24 |
| 1912345596 | Mcmillian's Community Care Home | Residential Treatment Facility, Physical Disabilities | 5748 Knightner St, Columbia, SC 29203-3508 | 2013-06-05 |
| 1427236785 | Health Related Personnel Services, Inc. | Residential Treatment Facility, Physical Disabilities | 1157 Spring St, Greenwood, SC 29646-3833 | 2008-02-08 |
| City | GRAY COURT |
| Zip Code | 29645 |
Please comment or provide details below to improve the information on JOHNNA REVIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.