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NPI Code Detail

MEDICARE: TITO RAVINE CASE MANAGER

MEDICARE: TITO RAVINE CASE MANAGER
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
1106S00000XBehavior TechnicianRBT-23-293969AR
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1346729605
Entity Type Code : Individual
Provider Name (Legal Business Name) : TITO RAVINE CASE MANAGER
Provider Business Mailing Address
First Line : 1301 MUSEUM RD
Second Line :
City : CONWAY
State : AR
Zip : 72032-4739
Country : US
Telephone Number : 501-358-6535
Fax Number : 501-358-6536
Provider Business Practice Location Address
First Line : 1301 MUSEUM RD
Second Line :
City : CONWAY
State : AR
Zip : 72032-4739
Country : US
Telephone Number : 501-358-6535
Fax Number : 501-358-6536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2018
Last Update Date : 03/03/2025

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