Organization
EVERNORTH DIRECT HEALTH LLC
Active
Parent organization
MEDVANTX INC
Other names
MOHAWK HEALTHY LIFE CENTER - OAK RIVER SC
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
2094 MARLBORO RD, BENNETTSVILLE, SC 29512
(843) 528-3696
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
RN3361
SC
Other
Enumeration date
06/06/2012
Last updated
05/03/2021
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