Provider Demographics
NPI:1700524337
Name:THE RAPHA PLACE LLC
Entity Type:Organization
Organization Name:THE RAPHA PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MATERNAL CHILD COMMUNITY HEALTH WOR
Authorized Official - Prefix:
Authorized Official - First Name:CALVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MCCHW
Authorized Official - Phone:352-872-6024
Mailing Address - Street 1:19670 SW EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-3650
Mailing Address - Country:US
Mailing Address - Phone:352-872-6024
Mailing Address - Fax:
Practice Address - Street 1:19670 SW EAGLE DR
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-3650
Practice Address - Country:US
Practice Address - Phone:352-872-6024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty