Organization
EVERNORTH DIRECT HEALTH LLC
Active
Parent organization
MEDVANTX, INC.
Other names
Roanoke Healthy Life Center- Mohawk
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
1026 LAFAYETTE HWY, ROANOKE, AL 36274-7250
(334) 863-7410
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
DO436
AL
Other
Enumeration date
11/15/2013
Last updated
05/03/2021
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