| Revolve Wellness Hub LLC | |
|
1190 Winterson Rd Ste 200 Linthicum MD 21090-2245 | |
| (443) 201-6063 | |
| Not Available |
| Full Name | Revolve Wellness Hub LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1190 Winterson Rd Ste 200, Linthicum, Maryland |
| Authorized Official Name and Position | Uzoamaka Mbadugha (CRNP-PMH) |
| Authorized Official Contact | 4432016063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolve Wellness Hub LLC 1190 Winterson Rd Ste 200 Linthicum MD 21090-2245 Ph: (443) 318-3289 | Revolve Wellness Hub LLC 1190 Winterson Rd Ste 200 Linthicum MD 21090-2245 Ph: (443) 201-6063 |
| NPI Number | 1174362974 |
|---|---|
| Provider Enumeration Date | 05/21/2024 |
| Last Update Date | 04/20/2026 |
| Certification Date | 04/20/2026 |
| Medicare PECOS PAC ID | 4688188410 |
|---|---|
| Medicare Enrollment ID | O20250703003852 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174362974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (NU) | Primary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (NU) | Secondary |
| Provider Name | Uzoamaka Mbadugha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912606385 PECOS PAC ID: 1850758335 Enrollment ID: I20230530001136 |
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