Provider Demographics
NPI:1679970065
Name:M&VJ ENTERPRISE 1, INC
Entity type:Organization
Organization Name:M&VJ ENTERPRISE 1, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-290-1714
Mailing Address - Street 1:909 SE EVERETT MALL WAY
Mailing Address - Street 2:SUITE C319
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3746
Mailing Address - Country:US
Mailing Address - Phone:425-290-1714
Mailing Address - Fax:425-290-1684
Practice Address - Street 1:909 SE EVERETT MALL WAY
Practice Address - Street 2:SUITE C319
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3746
Practice Address - Country:US
Practice Address - Phone:425-290-1714
Practice Address - Fax:425-290-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60142704253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care