REVITALIZE HEALTHCARE, INC (NPI# 1972007128) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972007128 |
| Entity Type | Organization |
| Organization Name | REVITALIZE HEALTHCARE, INC |
| Practice Address |
657 Lone Oak Rd Ste 2 Paducah KY 42003-4547 |
| Practice Telephone | 2705561630 |
| Mailing Telephone | 2705561630 |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2018-03-22 |
| Authorized Official Name | DR. HENRY D BABENCO (CEO) |
| Authorized Official Telephone | 2705561630 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 803a Country Club Ln, Hopkinsville, KY 422401370 | 2705561630 |
| Street Address |
657 LONE OAK RD STE 2 |
| City | PADUCAH |
| State | KY |
| Zip Code | 42003-4547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023591617 | Laurie K. Ballew | Psychiatry & Neurology | 657 Lone Oak Rd Ste 2, Paducah, KY 42003-4547 | 2018-09-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033757638 | Wilson Medical Staffing Pllc | Nurse Practitioner | 3130 Lone Oak Rd, Paducah, KY 42003 | 2019-12-13 |
| 1417415993 | Lauren Deanne Mcclain | Nurse Practitioner | 225 Medical Center Dr Ste 205, Paducah, KY 42003 | 2019-03-04 |
| 1871057042 | Brame Psychological Assessment Center | Psychologist | Ray and Kay Eckstein Outreach Center, 435 Berger Rd, Paducah, KY 42003 | 2019-01-22 |
| 1831611219 | Elizabeth Anne Wright | Social Worker | 425 Broadway Street, Paducah, KY 42003 | 2017-07-07 |
| 1558804724 | Kayla Reshea Franklin | Behavior Technician | 2075 Husband Road, Paducah, KY 42003 | 2016-11-21 |
| 1699189308 | Sunrise Children's Services, Inc. | Foster Care Agency | 3565 Lone Oak Rd Ste 2, Paducah, KY 42003 | 2014-06-20 |
| 1326488891 | Alice Ann Higdon Wilham | Surgery | 1532 Lone Oak Rd Ste 235, Paducah, KY 42003 | 2013-06-28 |
| 1881924611 | Meghan Ashley Lee | Nurse Practitioner | 1532 Lone Oak Rd Ste 245, Paducah, KY 42003 | 2009-12-29 |
| 1174771018 | Sleep Source Kentucky, LLC | Clinic/Center | 3125 Parisa Drive, Paducah, KY 42003 | 2008-09-04 |
| 1851547426 | Zandra Bristol Farley | Registered Nurse | 1532 Lone Oak Road Suite 445, Lourdes Marshall Nemer Pavillion, Paducah, KY 42003 | 2008-08-14 |
| Find all providers in zip 42003 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285103937 | A Newco LLC | Psychiatry & Neurology | 700 Envoy Cir # 702, Louisville, KY 40299-1812 | 2018-11-23 |
| 1487143806 | Fresh Start Health Psc | Psychiatry & Neurology | 336 29th St Ste 203, Ashland, KY 41101-1932 | 2018-05-02 |
| 1427269042 | Cheryl Yvonne Elizabeth Bailey Salary | Psychiatry & Neurology | 149 Grant Park Dr, Dayton, KY 41074-1745 | 2007-05-25 |
| 1306996079 | Michael G Kindred | Psychiatry & Neurology | 146 Deweese St, Lexington, KY 40507-1921 | 2007-01-12 |
| 1073548525 | Gary Clark Patton | Psychiatry & Neurology | 861 Corporate Dr, Lexington, KY 40503-5432 | 2006-07-12 |
| 1437186863 | Michelle Lofwall | Psychiatry & Neurology | 845 Angliana Ave, Lexington, KY 40508-3146 | 2006-06-28 |
| 1992267223 | Eastpoint Recovery Pllc | Psychiatry & Neurology | 13113 Eastpoint Park Blvd Ste C, Louisville, KY 40223-4191 | 2019-04-04 |
| 1366911893 | Isaiah House Inc | Psychiatry & Neurology | 975 Hustonville Rd Ste 7, Danville, KY 40422-2165 | 2018-11-14 |
| 1730342635 | Christina Shuman Wise | Psychiatry & Neurology | 351 Centre View Boulevard, Crestview Hills, KY 41017-3477 | 2008-07-10 |
| 1023281052 | Shri K Vaish | Psychiatry & Neurology | 627 W Fourth St, Lexington, KY 40508-1207 | 2008-04-10 |
| Find all providers with the same taxonomy | ||||
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| 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.