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General NPI Number Information
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NPI Number | 1801345277
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Entity Type | Organization
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Legal Business Name | EVA LIFE GIVER INC.
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 1528 COUNTRY RIDGE LN
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City | ESSEX
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State | MD
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Zip | 21221-3906
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Country | US
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Telephone | 410-661-0800
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Fax | 410-665-0400
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Provider Business Mailing Address
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Address Line | 5003 ARDMORE WAY BALTIMORE
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City | BALTIMORE
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State | MD
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Zip | 21206-5004
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Country | US
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Telephone | 443-271-8046
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Fax | 443-873-8959
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. EVA G. DEVAUGHN
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Credential |
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Telephone | 443-271-8046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 906059
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License Number State | MD
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