Healthcare Provider Details

I. General information

NPI: 1528971744
Provider Name (Legal Business Name): EVERNORTH DIRECT HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 WASHINGTON BLVD STE 443
ARLINGTON VA
22204-5719
US

IV. Provider business mailing address

2110 WASHINGTON BLVD STE 443
ARLINGTON VA
22204-5719
US

V. Phone/Fax

Practice location:
  • Phone: 555-555-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANNON CUSTER
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 706-483-5099