Provider Demographics
NPI:1033505706
Name:ESTATE VENTURES, LLC
Entity Type:Organization
Organization Name:ESTATE VENTURES, LLC
Other - Org Name:MCGREEVY NEUROHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-230-3006
Mailing Address - Street 1:559 W TWINCOURT TRL
Mailing Address - Street 2:#607
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8805
Mailing Address - Country:US
Mailing Address - Phone:904-230-3006
Mailing Address - Fax:
Practice Address - Street 1:559 W TWINCOURT TRL
Practice Address - Street 2:#607
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8805
Practice Address - Country:US
Practice Address - Phone:904-230-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1090282084N0400X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty