Healthcare Provider Details

I. General information

NPI: 1134691074
Provider Name (Legal Business Name): MVM GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21926 AVALON QUEEN DR
SPRING TX
77379-5922
US

IV. Provider business mailing address

21926 AVALON QUEEN DR
SPRING TX
77379-5922
US

V. Phone/Fax

Practice location:
  • Phone: 402-714-4484
  • Fax:
Mailing address:
  • Phone: 402-714-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KOKOU AKPO-GNANDI
Title or Position: CEO
Credential: RN
Phone: 402-714-4484