Provider Demographics
NPI:1982657623
Name:RAVEN BRUST, CHILDREN'S HOME HEALTH
Entity Type:Organization
Organization Name:RAVEN BRUST, CHILDREN'S HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:RAVEN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BRUST
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:812-483-8734
Mailing Address - Street 1:2800 KISSEL RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-7150
Mailing Address - Country:US
Mailing Address - Phone:812-483-8734
Mailing Address - Fax:812-963-1191
Practice Address - Street 1:2800 KISSEL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-7150
Practice Address - Country:US
Practice Address - Phone:812-483-8734
Practice Address - Fax:812-963-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INNEW AGENCY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health