Provider Demographics
NPI:1386351716
Name:MYRIAD EDUCATIONAL TRAINING AND SERVICES
Entity type:Organization
Organization Name:MYRIAD EDUCATIONAL TRAINING AND SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANSA
Authorized Official - Middle Name:KUUMBA
Authorized Official - Last Name:RA'IFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-955-1191
Mailing Address - Street 1:4831 COLUMBUS ST # 62982
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6703
Mailing Address - Country:US
Mailing Address - Phone:757-955-1191
Mailing Address - Fax:888-797-8187
Practice Address - Street 1:MYRIAD EDUCATIONAL TRAINING AND SERVICES, LLC
Practice Address - Street 2:2512 ARCHDALE DR
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456
Practice Address - Country:US
Practice Address - Phone:757-955-1191
Practice Address - Fax:888-797-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty