MEDICARE: RAVEN RIVERA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	172A00000X	Driver
2	376J00000X	Homemaker
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1902659360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN RIVERA

Provider Business Mailing Address
First Line	:	8605 HOPEWELL RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-4507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8621 HOPEWELL RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-4507
Country	:	US
Telephone Number	:	513-568-6198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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Directions to “ RAVEN RIVERA ” Practice Location

Language	Start Address	Practice Location

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