MEDICARE: RAVEN BRUST, CHILDREN'S HOME HEALTH

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
1	251E00000X	Home Health Agency	NEW AGENCY	IN

General Provider Information

NPI Number	:	1982657623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVEN BRUST, CHILDREN'S HOME HEALTH

Provider Business Mailing Address
First Line	:	2800 KISSEL RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-7150
Country	:	US
Telephone Number	:	812-483-8734
Fax Number	:	812-963-1191

Provider Business Practice Location Address
First Line	:	2800 KISSEL RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-7150
Country	:	US
Telephone Number	:	812-483-8734
Fax Number	:	812-963-1191

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	RAVEN BETH BRUST
Credential	:	NURSE
Telephone Number	:	812-483-8734

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/16/2008

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