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Individual
MR. WAYNE CHAVIS
Active
Individual
MR. WAYNE CHAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
364SHO200X
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364SHO200X
—
SC
Enumeration date
02/27/2017
Last updated
02/27/2017
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