Provider Demographics
NPI:1073381810
Name:EVOKE COCONUT CREEK LLC
Entity Type:Organization
Organization Name:EVOKE COCONUT CREEK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRO
Authorized Official - Prefix:
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:954-993-2040
Mailing Address - Street 1:3920 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:954-990-6305
Practice Address - Street 1:7618 MARGATE BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-3352
Practice Address - Country:US
Practice Address - Phone:954-993-2040
Practice Address - Fax:954-990-6305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOKE COCONUT CREEK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health