MEDICARE: ENVIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1366224164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVIVE LLC

Provider Business Mailing Address
First Line	:	4757 THE GROVE DR STE 172
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-8426
Country	:	US
Telephone Number	:	407-217-6308
Fax Number	:

Provider Business Practice Location Address
First Line	:	4757 THE GROVE DR STE 172
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-8426
Country	:	US
Telephone Number	:	407-217-6308
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CRAIG DAVIES
Credential	:	DC
Telephone Number	:	407-883-0149

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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Directions to “ENVIVE LLC ” Practice Location

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