=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356023261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVER WELL HEALTH SYSTEMS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2023
-----------------------------------------------------
Last Update Date | 10/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1880 LIVE OAK BLVD
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95991-1912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-242-0135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 JAMES WAY STE 250
-----------------------------------------------------
City | PISMO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93449-2877
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-242-0135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESINDET & CEO
-----------------------------------------------------
Name | DR. CHRISTOPHER LUIS ZUBIATE
-----------------------------------------------------
Credential | DHA, MSW
-----------------------------------------------------
Telephone | 805-242-0135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------