RAVEN ROCK HEALTH &WELLNESS NPI 1144978594

NPI Information

  • NPI: 1144978594
  • Provider Name: RAVEN ROCK HEALTH &WELLNESS
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 18D2257546
  • Address: 101 N MAIN ST
    STANTON, KY
    ZIP 40380
  • Phone: (859) 497-9508

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NPI Details

RAVEN ROCK HEALTH &WELLNESS is a primary care clinic center in Stanton, KY. RAVEN ROCK HEALTH &WELLNESS NPI is 1144978594. The provider is registered as an organization entity type.

The provider's business location address is:

101 N MAIN ST
STANTON, KY
ZIP 40380-174
Phone: (859) 497-9508

The provider's authorized official is Georgette Lee Greene .
The authorized official title is Managing Member and has the following contact phone number (606) 775-0515.

The CLIA number assigned to this NPI record is 18D2257546 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/15/2022 and was last updated on 6/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR1300XClinic/CenterRural HealthNo
2261QP2300XClinic/CenterPrimary CareYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17100897870MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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