Provider Demographics
NPI:1871005736
Name:REVELATION HOUSE CALLS INC
Entity type:Organization
Organization Name:REVELATION HOUSE CALLS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HANSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMAT
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:469-688-9800
Mailing Address - Street 1:1628 W HEBRON PKWY STE 138
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6311
Mailing Address - Country:US
Mailing Address - Phone:469-688-9800
Mailing Address - Fax:972-920-3399
Practice Address - Street 1:25 SHOREHAVEN LN
Practice Address - Street 2:
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-2938
Practice Address - Country:US
Practice Address - Phone:146-968-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty