MEDICARE: EVELYNE CHARLES

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	15-1698	FL

General Provider Information

NPI Number	:	1952251738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYNE CHARLES

Provider Business Mailing Address
First Line	:	5523 NW DOWNS ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-4006
Country	:	US
Telephone Number	:	772-240-6636
Fax Number	:	772-249-7002

Provider Business Practice Location Address
First Line	:	5523 NW DOWNS ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-4006
Country	:	US
Telephone Number	:	772-240-6636
Fax Number	:	772-249-7002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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Directions to “ EVELYNE CHARLES ” Practice Location

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