Organization
RAVEN ROCK HEALTH &WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGETTE LEE GREENE APRN (MANAGING MEMBER)
(606) 775-0515
Entity
Organization
Contact information
Practice address
101 N MAIN ST, STANTON, KY 40380-2174
(859) 497-9508
Mailing address
101 N MAIN ST, STANTON, KY 40380-2174
(606) 775-0515
(606) 775-0515
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100897870
—
KY
Enumeration date
03/15/2022
Last updated
06/10/2023
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