Provider Demographics
NPI:1891479796
Name:RAVEN VALLEY HEALTH SERVICES
Entity Type:Organization
Organization Name:RAVEN VALLEY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:NGENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:198-022-5277
Mailing Address - Street 1:916 EARL RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6810
Mailing Address - Country:US
Mailing Address - Phone:198-022-5277
Mailing Address - Fax:
Practice Address - Street 1:916 EARL RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6810
Practice Address - Country:US
Practice Address - Phone:198-022-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care