1134598022 NPI number — EVER WELL HEALTH SYSTEMS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134598022 NPI number — EVER WELL HEALTH SYSTEMS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVER WELL HEALTH SYSTEMS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ENCLAVE AT THE FOOTHILLS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134598022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
391 FRONT ST
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
GROVER BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93433-1553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-242-0135
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10650 ROAD 256
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRA BELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93270-9721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-242-0135
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZUBIATE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
LUIS
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
805-242-0135

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)