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General NPI Number Information
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NPI Number | 1841165198
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Entity Type | Organization
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Legal Business Name | WHIT RAVEN ADULT CARE HOME LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 203 SNEAD RD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6830
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Country | US
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Telephone | 336-293-6664
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Fax |
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Provider Business Mailing Address
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Address Line | 203 SNEAD RD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6830
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Country | US
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Telephone | 336-293-6664
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | RODERICK GIST
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Credential |
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Telephone | 336-287-8789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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