Provider Demographics
NPI:1740274521
Name:NEVAEH & COMPANY LLC
Entity type:Organization
Organization Name:NEVAEH & COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-806-2936
Mailing Address - Street 1:2491 ARMSTRONG DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6813
Mailing Address - Country:US
Mailing Address - Phone:336-776-1599
Mailing Address - Fax:336-661-9378
Practice Address - Street 1:2491 ARMSTRONG DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6813
Practice Address - Country:US
Practice Address - Phone:336-776-1599
Practice Address - Fax:336-661-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00310332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3405962OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3405962OtherNCPDP PROVIDER IDENTIFICATION NUMBER