Revita Life

NPI #1225139439 in Detroit, Michigan

Provider Information

NPI Number: 1225139439
Entity Type: Organization
Organization Name: Revita Life
Primary Specialty: Dietary Manager
Enumeration Date: Sep 26, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 4106 JOHN R
Address 2: SUITE 805
City: Detroit
State: Michigan
ZIP Code: 48201
Phone: (313) 745-7454

Authorized Official

Name: DR. ANDRE R NUNN, M.D.
Title: PRESIDENT
Phone: (313) 745-7454

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dietary Manager	132700000X	Primary

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