Provider Demographics
NPI:1467116764
Name:AV LEGACY SERVICES
Entity Type:Organization
Organization Name:AV LEGACY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ATAVEUS
Authorized Official - Middle Name:DUVALL
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-589-5566
Mailing Address - Street 1:202 AQUA CT # 202
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4284
Mailing Address - Country:US
Mailing Address - Phone:703-589-5566
Mailing Address - Fax:
Practice Address - Street 1:202 AQUA CT # 202
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4284
Practice Address - Country:US
Practice Address - Phone:703-589-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE ATAVEUS CASH LEGACY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care