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General NPI Number Information
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NPI Number | 1790644516
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Entity Type | Organization
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Legal Business Name | AEVUM INTEGRATED HEALTH VA LLC
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 202 AGEE ST
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City | FARMVILLE
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State | VA
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Zip | 23901-2617
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Country | US
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Telephone | 434-603-4835
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Fax |
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Provider Business Mailing Address
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Address Line | 175 ROUTE 70 STE 303
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City | TOMS RIVER
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State | NJ
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Zip | 08755-0936
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Country | US
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Telephone | 434-603-4835
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LEVI LIPOVENKO
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Credential |
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Telephone | 434-603-4835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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