Provider Demographics
NPI:1225556772
Name:MARVA ONE LLC
Entity Type:Organization
Organization Name:MARVA ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:IOAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:AVRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-418-5115
Mailing Address - Street 1:2334 W FETLOCK TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5767
Mailing Address - Country:US
Mailing Address - Phone:602-418-5115
Mailing Address - Fax:623-388-3835
Practice Address - Street 1:2334 W FETLOCK TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5767
Practice Address - Country:US
Practice Address - Phone:602-418-5115
Practice Address - Fax:623-388-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5228251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health