MEDICARE: THE RAVEN SCHOOL GULF COAST TRADE CENTER

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1851432686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RAVEN SCHOOL GULF COAST TRADE CENTER

Provider Business Mailing Address
First Line	:	143 FOREST SERVICE ROAD 233
Second Line	:
City	:	NEW WAVERLY
State	:	TX
Zip	:	77358-3945
Country	:	US
Telephone Number	:	936-344-7851
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 FOREST SERVICE ROAD 233
Second Line	:
City	:	NEW WAVERLY
State	:	TX
Zip	:	77358-3945
Country	:	US
Telephone Number	:	936-344-7851
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT FINANCE DIRECTOR
Name	:	DIANE WOOD
Credential	:
Telephone Number	:	936-344-7851

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	08/22/2020

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Directions to “THE RAVEN SCHOOL GULF COAST TRADE CENTER ” Practice Location

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