Provider Demographics
NPI:1467923946
Name:SHOPJVEON LLC
Entity Type:Organization
Organization Name:SHOPJVEON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYVEON
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-415-7664
Mailing Address - Street 1:PO BOX 143052
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614
Mailing Address - Country:US
Mailing Address - Phone:904-415-7664
Mailing Address - Fax:
Practice Address - Street 1:15402 HIDDEN FOAL DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32234
Practice Address - Country:US
Practice Address - Phone:904-415-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHOPJVEON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care