Provider Demographics
NPI:1447809041
Name:VALDEVIN LLC
Entity type:Organization
Organization Name:VALDEVIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:BALOGUN
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-495-8345
Mailing Address - Street 1:PO BOX 4020
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34692-1020
Mailing Address - Country:US
Mailing Address - Phone:727-495-8345
Mailing Address - Fax:
Practice Address - Street 1:2746 BIG PINE DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-8763
Practice Address - Country:US
Practice Address - Phone:727-495-8345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities