Provider Demographics
NPI:1619694346
Name:EVA LIFE GIVER INC.
Entity Type:Organization
Organization Name:EVA LIFE GIVER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVAUGHN-BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CAC-AD, AS
Authorized Official - Phone:443-271-8046
Mailing Address - Street 1:4804 YORK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4401
Mailing Address - Country:US
Mailing Address - Phone:443-873-8958
Mailing Address - Fax:443-873-8959
Practice Address - Street 1:5003 ARDMORE WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5004
Practice Address - Country:US
Practice Address - Phone:443-271-8046
Practice Address - Fax:443-873-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1801345277Medicaid
MD1831622315Medicaid
MD14477619507Medicaid
MD1003210873Medicaid
MD1093248577Medicaid
MD1699076562Medicaid