Provider Demographics
NPI:1720419062
Name:RAVEON 1947
Entity Type:Organization
Organization Name:RAVEON 1947
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:941-685-0265
Mailing Address - Street 1:9040 TOWN CENTER PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4101
Mailing Address - Country:US
Mailing Address - Phone:941-552-5656
Mailing Address - Fax:941-552-5650
Practice Address - Street 1:9040 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-4101
Practice Address - Country:US
Practice Address - Phone:941-552-5656
Practice Address - Fax:941-552-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health