Healthcare Provider Details

I. General information

NPI: 1689173304
Provider Name (Legal Business Name): MVM HOME IMPROVEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 SCHOOL LN
SOUTHAMPTON PA
18966-4712
US

IV. Provider business mailing address

1040 SCHOOL LN
SOUTHAMPTON PA
18966-4712
US

V. Phone/Fax

Practice location:
  • Phone: 561-676-8589
  • Fax:
Mailing address:
  • Phone: 561-676-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberPA136624
License Number StatePA

VIII. Authorized Official

Name: MARYANA GORIVODSKAYA
Title or Position: COO
Credential:
Phone: 917-957-7774