Organization
EVERNORTH DIRECT HEALTH LLC
Active
Parent organization
MEDVANTX, INC.
Other names
MOHAWK HEALTHY LIFE CENTER - MILES/DVD
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
531 DUVALL RD, CHATSWORTH, GA 30705-2087
(706) 422-6104
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
002396
GA
Other
Enumeration date
05/16/2011
Last updated
05/03/2021
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