Provider Demographics
NPI:1427788116
Name:EVERGLOW LLC
Entity type:Organization
Organization Name:EVERGLOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZVISINEI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEKI
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:757-949-0950
Mailing Address - Street 1:4144 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1600
Mailing Address - Country:US
Mailing Address - Phone:757-949-0950
Mailing Address - Fax:757-966-2788
Practice Address - Street 1:4144 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-1600
Practice Address - Country:US
Practice Address - Phone:757-949-0950
Practice Address - Fax:757-966-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services