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General NPI Number Information
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NPI Number | 1972276699
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Entity Type | Organization
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Legal Business Name | EVOKE COCONUT CREEK LLC
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 3920 NW 43RD ST
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3462
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Country | US
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Telephone | 954-993-2040
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Fax | 954-990-6305
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Provider Business Mailing Address
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Address Line | 3920 NW 43RD ST
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3462
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Country | US
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Telephone | 954-993-2040
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Fax | 954-990-6305
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Authorized Official
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Title or Position | COO
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Name | SHERITA C CHANG
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Credential | MS
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Telephone | 954-993-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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