Provider Demographics
NPI:1417627894
Name:RAVANT SENIOR CARE LLC
Entity Type:Organization
Organization Name:RAVANT SENIOR CARE LLC
Other - Org Name:RAVANT LAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-263-3701
Mailing Address - Street 1:7842 WESSEX LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2557
Mailing Address - Country:US
Mailing Address - Phone:843-263-3701
Mailing Address - Fax:803-764-4650
Practice Address - Street 1:136 FORUM DR STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7980
Practice Address - Country:US
Practice Address - Phone:803-761-9010
Practice Address - Fax:803-764-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No251E00000XAgenciesHome Health