MEDICARE: EVERNIA HEALTH CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1366002156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERNIA HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	950 EVERNIA ST STE 311-320
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5735
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 EVERNIA ST STE 311-320
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5735
Country	:	US
Telephone Number	:	561-469-0781
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAWRENCE HAWKINS
Credential	:
Telephone Number	:	561-662-8146

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	06/14/2019

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