Organization
EVERNORTH DIRECT HEALTH LLC
Active
Parent organization
MEDVANTX, INC.
Other names
MOHAWK HEALTHY LIFE CENTER AT ANTIOCH
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
2001 ANTIOCH RD, DALTON, GA 30721-4622
(706) 275-7660
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
RN213704
GA
Other
Enumeration date
01/18/2011
Last updated
05/03/2021
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