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General NPI Number Information
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NPI Number | 1659956910
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Entity Type | Organization
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Legal Business Name | EVERNORTH DIRECT HEALTH LLC
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 1350 FRANKLIN GROVE RD
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City | DIXON
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State | IL
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Zip | 61021-9148
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Country | US
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Telephone | 815-285-6749
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Fax | 815-285-6747
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Provider Business Mailing Address
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Address Line | 1350 FRANKLIN GROVE RD
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City | DIXON
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State | IL
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Zip | 61021-9148
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Country | US
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Telephone | 815-285-6749
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Fax | 815-285-6747
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Authorized Official
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Title or Position | FINANCIAL ANALYSIS SENIOR MANAGER
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Name | DEBORAH SUE COOLIDGE
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Credential |
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Telephone | 623-277-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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