Provider Demographics
NPI:1699233973
Name:RAVIKO GROUP LLC
Entity type:Organization
Organization Name:RAVIKO GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISIDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-623-3026
Mailing Address - Street 1:351 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:CLIFFWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07721-1215
Mailing Address - Country:US
Mailing Address - Phone:732-441-1800
Mailing Address - Fax:732-441-1808
Practice Address - Street 1:351 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721-1215
Practice Address - Country:US
Practice Address - Phone:732-441-1800
Practice Address - Fax:732-441-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness