Provider Demographics
NPI:1528212412
Name:ATLANTIC ELEVATORS OF VIRGINIA, LLC
Entity Type:Organization
Organization Name:ATLANTIC ELEVATORS OF VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-749-9532
Mailing Address - Street 1:2589 QUALITY CT STE 316
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5324
Mailing Address - Country:US
Mailing Address - Phone:757-749-9532
Mailing Address - Fax:757-201-6034
Practice Address - Street 1:2589 QUALITY CT STE 316
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5324
Practice Address - Country:US
Practice Address - Phone:757-749-9532
Practice Address - Fax:757-201-6034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment