Provider Demographics
NPI:1588180426
Name:SIVAD PRODUCTIONS, INC
Entity Type:Organization
Organization Name:SIVAD PRODUCTIONS, INC
Other - Org Name:PRIME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MASTERS DEGREE IN HEALTH PSYCHOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:DUDLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:207-272-0982
Mailing Address - Street 1:110 MARGINAL WAY # 9715-181
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2442
Mailing Address - Country:US
Mailing Address - Phone:207-272-0982
Mailing Address - Fax:
Practice Address - Street 1:1 STUYVESANT OVAL APT 2G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2140
Practice Address - Country:US
Practice Address - Phone:207-272-0982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIVAD PRODUCTIONS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251E00000XAgenciesHome Health