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General NPI Number Information
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NPI Number | 1003311267
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Entity Type | Organization
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Legal Business Name | EVOYENT HEALTH FOUNDATION
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 201 S ORANGE AVE STE 900
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City | ORLANDO
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State | FL
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Zip | 32801-5008
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Country | US
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Telephone | 321-282-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 8297 CHAMPIONS GATE BLVD # 446
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City | CHAMPIONS GATE
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State | FL
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Zip | 33896-8387
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Country | US
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Telephone | 321-282-1999
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHANA FAIR
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Credential |
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Telephone | 321-282-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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