Provider Demographics
NPI:1396097341
Name:EASTERN VIRGINIA ADULT CARE, LLC
Entity type:Organization
Organization Name:EASTERN VIRGINIA ADULT CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-898-7524
Mailing Address - Street 1:13193 WARWICK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8320
Mailing Address - Country:US
Mailing Address - Phone:757-898-7524
Mailing Address - Fax:
Practice Address - Street 1:13193 WARWICK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8320
Practice Address - Country:US
Practice Address - Phone:757-898-7524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
VA2066251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management