Organization
EVANS LOGISTIC SERVICES LLC
Active
Other names
Evans Logistic Services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE EVANS (MEDICAID WAIVER PROVIDER)
(352) 361-2968
Entity
Organization
Contact information
Practice address
12630 NW 38TH AVE, REDDICK, FL 32686-4067
(352) 361-2968
Mailing address
12630 NW 38TH AVE, REDDICK, FL 32686-4067
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
06/21/2019
Last updated
06/21/2019
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