Provider Demographics
NPI:1558577023
Name:RAVEN HILL INTEGRATED THERAPIES, LLC
Entity Type:Organization
Organization Name:RAVEN HILL INTEGRATED THERAPIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:MOLATCH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:207-664-6116
Mailing Address - Street 1:185 STATE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1830
Mailing Address - Country:US
Mailing Address - Phone:207-664-6116
Mailing Address - Fax:
Practice Address - Street 1:185 STATE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1830
Practice Address - Country:US
Practice Address - Phone:207-664-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME10880893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME 1948Medicare PIN
ME5827720001Medicare NSC