Provider Demographics
NPI:1497997993
Name:RAVENS EXTENDED SERVICES, LLC
Entity Type:Organization
Organization Name:RAVENS EXTENDED SERVICES, LLC
Other - Org Name:RAVENS EXTENDED SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-572-6360
Mailing Address - Street 1:3163 RIVER LANDING DR
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-2170
Mailing Address - Country:US
Mailing Address - Phone:225-572-6360
Mailing Address - Fax:225-383-4035
Practice Address - Street 1:3163 RIVER LANDING DR
Practice Address - Street 2:
Practice Address - City:ADDIS
Practice Address - State:LA
Practice Address - Zip Code:70710-2170
Practice Address - Country:US
Practice Address - Phone:225-572-6360
Practice Address - Fax:225-383-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)