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General NPI Number Information
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NPI Number | 1841544343
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Entity Type | Organization
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Legal Business Name | AREVV INC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 328 N GREAT NECK RD SUITE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-4060
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Country | US
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Telephone | 757-965-6823
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Fax |
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Provider Business Mailing Address
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Address Line | 740 WATERS DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-4882
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Country | US
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Telephone | 757-717-8880
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND OWNER
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Name | MRS. VERA LOUISE MANTACK
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Credential | COSMETOLOGIST
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Telephone | 757-717-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 1201103891
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License Number State | VA
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