1053030643 NPI number — EVERNORTH BEHAVIORAL CARE GROUP OF FLORIDA, P.A.

Table of content: (NPI 1053030643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053030643 NPI number — EVERNORTH BEHAVIORAL CARE GROUP OF FLORIDA, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERNORTH BEHAVIORAL CARE GROUP OF FLORIDA, P.A.
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:
Provider Other Organization Name Type Code:
6
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:
1053030643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 MARKET ST FL 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94105-3316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 TECHNOLOGY PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-501-7991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
LEGAL COUNSEL
Authorized Official Telephone Number:
843-540-7108

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com