Healthcare Provider Details

I. General information

NPI: 1487213880
Provider Name (Legal Business Name): CHARLES EVANS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

IV. Provider business mailing address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-2388
  • Fax: 516-759-5240
Mailing address:
  • Phone: 516-676-2388
  • Fax: 516-759-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY CODY
Title or Position: BILLING MANAGER
Credential:
Phone: 516-676-2388