MEDICARE: RAVEN ROCK HEALTH &WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144978594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVEN ROCK HEALTH &WELLNESS

Provider Business Mailing Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2174
Country	:	US
Telephone Number	:	606-775-0515
Fax Number	:	606-775-0515

Provider Business Practice Location Address
First Line	:	101 N MAIN ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2174
Country	:	US
Telephone Number	:	859-497-9508
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	GEORGETTE LEE GREENE
Credential	:	APRN
Telephone Number	:	606-775-0515

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	06/10/2023

Similar Medicare Providers

1861869752 — HEATHER E. DEEL APRN, FNP-C
Practice Location Address:

101 N MAIN ST
STANTON, KY
40380-2174

Practice Phone: 606-775-0515
Practice Fax: 606-552-0964

1700322385 — GEORGETTE GREENE APRN
Practice Location Address:

101 N MAIN ST
STANTON, KY
40380-2174

Practice Phone: 606-775-0515
Practice Fax: 606-552-0694

1003897273 — DR. GARY M THOMPSON DMD
Practice Location Address:

131 N MAIN ST
STANTON, KY
40380-2174

Practice Phone: 606-663-2133
Practice Fax: 606-663-0699

1013444918 — CONNECTIVE HEALING LLC
Practice Location Address:

101 N MAIN ST
STANTON, KY
40380-2174

Practice Phone: 859-230-5957
Practice Fax:

1972259356 — ASHLEY NICOLE VANHOOSE LCSW
Practice Location Address:

101 N MAIN ST
STANTON, KY
40380-2174

Practice Phone: 606-284-6674
Practice Fax:

1780683524 — COUNTY OF POWELL
Practice Location Address:

56 ATKINSON ST
STANTON, KY
40380-2514

Practice Phone: 606-663-0376
Practice Fax: 304-521-1576

Directions to “RAVEN ROCK HEALTH &WELLNESS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.