Provider Demographics
NPI:1265833081
Name:MDEVANS LLC
Entity Type:Organization
Organization Name:MDEVANS LLC
Other - Org Name:MDEVANS ADULT RESIDENTIAL & DSS TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FIATA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-496-9604
Mailing Address - Street 1:5660 E VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5660 E VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2468
Practice Address - Country:US
Practice Address - Phone:757-469-9604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA916149251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health