Provider Demographics
NPI:1679030951
Name:SIROV LLC
Entity Type:Organization
Organization Name:SIROV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-313-6018
Mailing Address - Street 1:5 HOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3837
Mailing Address - Country:US
Mailing Address - Phone:856-313-6018
Mailing Address - Fax:
Practice Address - Street 1:5 HOGAN WAY
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3837
Practice Address - Country:US
Practice Address - Phone:856-313-6018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services