Provider Demographics
NPI:1063046324
Name:EVAC GROUP LLC
Entity type:Organization
Organization Name:EVAC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIONA
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-937-3688
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-8323
Mailing Address - Country:US
Mailing Address - Phone:804-937-3688
Mailing Address - Fax:
Practice Address - Street 1:2815 FORBS AVE STE 107
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-3731
Practice Address - Country:US
Practice Address - Phone:804-937-3688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)