Provider Demographics
NPI:1952030645
Name:RAVEN CARES INC
Entity Type:Organization
Organization Name:RAVEN CARES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-207-6617
Mailing Address - Street 1:259 OLD FLEMINGSBURG RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1090
Mailing Address - Country:US
Mailing Address - Phone:606-356-2157
Mailing Address - Fax:
Practice Address - Street 1:259 OLD FLEMINGSBURG RD STE 101
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1090
Practice Address - Country:US
Practice Address - Phone:859-494-2656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder