Provider Demographics
NPI:1699564120
Name:ST. DAVON, LLC
Entity type:Organization
Organization Name:ST. DAVON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:VISANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-618-9040
Mailing Address - Street 1:3901 ARLINGTON HIGHLANDS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-6050
Mailing Address - Country:US
Mailing Address - Phone:614-618-9040
Mailing Address - Fax:
Practice Address - Street 1:3901 ARLINGTON HIGHLANDS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-6050
Practice Address - Country:US
Practice Address - Phone:614-618-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care