Provider Demographics
NPI:1265137889
Name:EMANVI LLC
Entity type:Organization
Organization Name:EMANVI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAUN
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:850-624-5401
Mailing Address - Street 1:317 BOGHT RD
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1106
Mailing Address - Country:US
Mailing Address - Phone:850-624-5401
Mailing Address - Fax:
Practice Address - Street 1:317 BOGHT RD
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-1106
Practice Address - Country:US
Practice Address - Phone:850-624-5401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty