Provider Demographics
NPI:1417265737
Name:DUVALL HOMES, INC
Entity Type:Organization
Organization Name:DUVALL HOMES, INC
Other - Org Name:THE DUVALL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-734-2874
Mailing Address - Street 1:827 S SPRING GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-6648
Mailing Address - Country:US
Mailing Address - Phone:386-734-2874
Mailing Address - Fax:386-734-5504
Practice Address - Street 1:827 S SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-6648
Practice Address - Country:US
Practice Address - Phone:386-734-2874
Practice Address - Fax:386-734-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL09-12-063320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023863596Medicaid