Provider Demographics
NPI:1174348379
Name:CIVITAS PARA VITA LIMITED LIABILITY CO
Entity type:Organization
Organization Name:CIVITAS PARA VITA LIMITED LIABILITY CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:SIOTIA BEATRICE
Authorized Official - Last Name:HURDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-917-1211
Mailing Address - Street 1:875 IRON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-3937
Mailing Address - Country:US
Mailing Address - Phone:434-917-1211
Mailing Address - Fax:
Practice Address - Street 1:875 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-3937
Practice Address - Country:US
Practice Address - Phone:434-917-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care