Provider Demographics
NPI:1477851129
Name:MAVUNO,LLC
Entity Type:Organization
Organization Name:MAVUNO,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:TOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-797-9053
Mailing Address - Street 1:3350 FOOTBRIDGE LN
Mailing Address - Street 2:SUITE124/125
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-9694
Mailing Address - Country:US
Mailing Address - Phone:910-797-9053
Mailing Address - Fax:
Practice Address - Street 1:3350 FOOTBRIDGE LN
Practice Address - Street 2:SUITE124/125
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-9694
Practice Address - Country:US
Practice Address - Phone:910-797-9053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)