Provider Demographics
NPI:1902605918
Name:RAVENALA VENTURES LLC
Entity type:Organization
Organization Name:RAVENALA VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-635-5624
Mailing Address - Street 1:9098 BROADWAY TER
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1952
Mailing Address - Country:US
Mailing Address - Phone:415-635-5624
Mailing Address - Fax:
Practice Address - Street 1:1221 FARMERS LN STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6712
Practice Address - Country:US
Practice Address - Phone:707-843-5192
Practice Address - Fax:707-978-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care