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General NPI Number Information
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NPI Number | 1568996734
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Entity Type | Organization
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Legal Business Name | EVALVE LIFE CO
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 11360 NW 29TH ST
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City | SUNRISE
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State | FL
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Zip | 33323-1659
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Country | US
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Telephone | 954-592-5831
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Fax | 727-313-9561
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Provider Business Mailing Address
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Address Line | 6990 NW 23RD ST
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City | MARGATE
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State | FL
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Zip | 33063-2029
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Country | US
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Telephone | 954-609-3523
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMEIKA DAVIS
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Credential | NP
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Telephone | 954-609-3523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | FL
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