Healthcare Provider Details

I. General information

NPI: 1164253373
Provider Name (Legal Business Name): RAVENSCROFT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 18TH ST
NORFOLK NE
68701-3651
US

IV. Provider business mailing address

401 N 18TH ST
NORFOLK NE
68701-3651
US

V. Phone/Fax

Practice location:
  • Phone: 402-644-7375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOON BURNAM
Title or Position: TREASURER
Credential:
Phone: 949-540-1249