Provider Demographics
NPI:1275411381
Name:CHARLES EVANS CENTER, INC
Entity type:Organization
Organization Name:CHARLES EVANS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-622-8888
Mailing Address - Street 1:2146 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2606
Mailing Address - Country:US
Mailing Address - Phone:516-622-8888
Mailing Address - Fax:
Practice Address - Street 1:2146 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2606
Practice Address - Country:US
Practice Address - Phone:516-622-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES EVANS CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health