Healthcare Provider Details

I. General information

NPI: 1215596614
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: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 JACKSON AVE
SEAFORD NY
11783-2606
US

IV. Provider business mailing address

2146 JACKSON AVE
SEAFORD NY
11783-2606
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-8888
  • Fax: 516-342-2480
Mailing address:
  • Phone: 516-622-8888
  • Fax: 516-342-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: REBECA ROSA RIVERA
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 516-622-8888