# EVERNORTH DIRECT HEALTH LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Johnston Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013401124
- **Authorized official:** DEBORAH SUE COOLIDGE (FINANCIAL ANALYSIS MANAGER)
- **Authorized official phone:** (623) 277-1170

## Contact information

- **Practice address:** 735 GREENVILLE AVE, BLDG D, JOHNSTON, RI 02919
- **Practice address phone:** (623) 277-1170
- **Mailing address:** 25500 N NORTERRA DR, PHOENIX, AZ 85085-8200
- **Mailing address phone:** (623) 277-1170

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/21/2018
- **Last updated:** 05/14/2021