| Raven Rock Health &wellness | |
|
101 N Main St Stanton KY 40380-2174 | |
| (859) 497-9508 | |
| Not Available |
| Full Name | Raven Rock Health &wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 N Main St, Stanton, Kentucky |
| Authorized Official Name and Position | Georgette Lee Greene (MANAGING MEMBER) |
| Authorized Official Contact | 6067750515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Raven Rock Health &wellness 101 N Main St Stanton KY 40380-2174 Ph: (606) 775-0515 | Raven Rock Health &wellness 101 N Main St Stanton KY 40380-2174 Ph: (859) 497-9508 |
| NPI Number | 1144978594 |
|---|---|
| Provider Enumeration Date | 03/15/2022 |
| Last Update Date | 06/10/2023 |
| Medicare PECOS PAC ID | 3173904174 |
|---|---|
| Medicare Enrollment ID | O20220722000533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144978594 | NPI | - | NPPES |
| 7100897870 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| Provider Name | Heather E Deel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861869752 PECOS PAC ID: 9931416609 Enrollment ID: I20150911001836 |
| Provider Name | Georgette Greene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700322385 PECOS PAC ID: 2264576610 Enrollment ID: I20170601002598 |
| Provider Name | Dana Conn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164172037 PECOS PAC ID: 1254712250 Enrollment ID: I20220725001163 |
| Provider Name | Ashley Nicole Vanhoose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972259356 PECOS PAC ID: 2769856095 Enrollment ID: I20230822000681 |
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