Organization
WHIT RAVEN ADULT CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODERICK GIST (OWNER/OPERATOR)
(336) 287-8789
Entity
Organization
Contact information
Practice address
203 SNEAD RD, WINSTON SALEM, NC 27103-6830
(336) 293-6664
Mailing address
203 SNEAD RD, WINSTON SALEM, NC 27103-6830
(336) 293-6664
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
10/07/2025
Last updated
10/07/2025
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