Healthcare Provider Details

I. General information

NPI: 1417627894
Provider Name (Legal Business Name): RAVANT SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WINDSOR CV STE 106
COLUMBIA SC
29223-1833
US

IV. Provider business mailing address

1 WINDSOR CV STE 106
COLUMBIA SC
29223-1833
US

V. Phone/Fax

Practice location:
  • Phone: 803-761-9010
  • Fax: 803-764-4650
Mailing address:
  • Phone: 803-761-9010
  • Fax: 803-764-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: STEFANIE R. GIFFORD
Title or Position: DIRECTOR
Credential:
Phone: 843-263-3701