Organization
RAVEN'S NEST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAVEN JACKSON M.S. (DIRECTOR)
(434) 210-0343
Entity
Organization
Contact information
Practice address
1247 FORT MITCHELL DR, CHASE CITY, VA 23924-5340
(434) 738-8493
Mailing address
1247 FORT MITCHELL DR, CHASE CITY, VA 23924-5340
(434) 738-8493
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2181
VA
Other
Enumeration date
05/08/2014
Last updated
05/08/2014
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