NPI 1225139439

Revita Life

Organisation Dietary Manager Detroit, MI

Practice location

Address: 4106 John R Suite 805, Detroit, MI 48201
Phone: (313) 745-7454
Fax: (313) 993-8625

Authorised official

Name: Andre R Nunn
Title: President
Phone: (313) 745-7454

Registered specialties

Dietary Manager Primary

Dietary & Nutritional Service Providers Taxonomy 132700000X Licence AN066667 (MI)

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Registry record

NPI: 1225139439
Entity type: Organization
NPI issued: 26 Sep 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.