Healthcare Provider Details

I. General information

NPI: 1629227178
Provider Name (Legal Business Name): MAV INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 OAKWOOD AVE
RAEFORD NC
28376-3351
US

IV. Provider business mailing address

PO BOX 399
RAEFORD NC
28376-0399
US

V. Phone/Fax

Practice location:
  • Phone: 910-565-2522
  • Fax: 888-848-1195
Mailing address:
  • Phone: 910-565-2522
  • Fax: 888-848-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA JANE CALDWELL
Title or Position: PARTNER
Credential: BA, JD
Phone: 910-565-2522