Provider Demographics
NPI:1659716744
Name:CEVIAN HEALTH DISTRIBUTORS, LLC
Entity Type:Organization
Organization Name:CEVIAN HEALTH DISTRIBUTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-429-7381
Mailing Address - Street 1:20615 FENKELL ST UNIT 23851
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20615 FENKELL ST UNIT 23851
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-3745
Practice Address - Country:US
Practice Address - Phone:248-429-7381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5306004024332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies