Provider Demographics
NPI:1003311267
Name:EVOYENT HEALTH FOUNDATION
Entity Type:Organization
Organization Name:EVOYENT HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-282-1999
Mailing Address - Street 1:8297 CHAMPIONS GATE BLVD # 446
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8387
Mailing Address - Country:US
Mailing Address - Phone:321-282-1999
Mailing Address - Fax:
Practice Address - Street 1:201 S ORANGE AVE STE 900
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-5008
Practice Address - Country:US
Practice Address - Phone:321-282-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health