Provider Demographics
NPI:1922866128
Name:HATT, RAVEN MARCHIETTE
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:MARCHIETTE
Last Name:HATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEARS
Mailing Address - State:MI
Mailing Address - Zip Code:49679-8059
Mailing Address - Country:US
Mailing Address - Phone:231-629-9010
Mailing Address - Fax:
Practice Address - Street 1:6517 20TH AVE
Practice Address - Street 2:
Practice Address - City:SEARS
Practice Address - State:MI
Practice Address - Zip Code:49679-8059
Practice Address - Country:US
Practice Address - Phone:231-629-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home