Healthcare Provider Details

I. General information

NPI: 1073381810
Provider Name (Legal Business Name): EVOKE COCONUT CREEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 MARGATE BLVD
MARGATE FL
33063-3352
US

IV. Provider business mailing address

3920 NW 43RD ST
COCONUT CREEK FL
33073-3462
US

V. Phone/Fax

Practice location:
  • Phone: 954-993-2040
  • Fax: 954-990-6305
Mailing address:
  • Phone:
  • Fax: 954-990-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERITA CHANG
Title or Position: CRO
Credential: MS
Phone: 954-993-2040