Basic Information
| Provider Information | |||||||||
| NPI: | 1669560868 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RAVENWOOD HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RAVENWOOD NURSING AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40213 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708350213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257530864 | ||||||||
| FaxNumber: | 2257530948 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108374990 | ||||||||
| FaxNumber: | 4106850002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PITTMAN | ||||||||
| AuthorizedOfficialFirstName: | CINDIE | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2257530864 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 30-067 | MD | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.