Provider Demographics
NPI:1649650086
Name:EVI-BASE,LLC
Entity type:Organization
Organization Name:EVI-BASE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-752-4427
Mailing Address - Street 1:32376 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1812
Mailing Address - Country:US
Mailing Address - Phone:440-752-4427
Mailing Address - Fax:
Practice Address - Street 1:4807 ROCKSIDE RD
Practice Address - Street 2:SUITE 740
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2192
Practice Address - Country:US
Practice Address - Phone:216-215-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty