Organization
EVERNORTH DIRECT HEALTH LLC
Active
Parent organization
MEDVANTX, INC.
Other names
MOHAWK HEALTHY LIFE CENTER - GREEN STREET
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
508 E MORRIS ST, DALTON, GA 30721-3403
(706) 272-1465
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
RN225780
GA
Other
Enumeration date
12/09/2011
Last updated
05/03/2021
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