Provider Demographics
NPI:1659956910
Name:EVERNORTH DIRECT HEALTH LLC
Entity Type:Organization
Organization Name:EVERNORTH DIRECT HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ANALYSIS SENIOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COOLIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-277-1170
Mailing Address - Street 1:1350 FRANKLIN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-9148
Mailing Address - Country:US
Mailing Address - Phone:815-285-6749
Mailing Address - Fax:815-285-6747
Practice Address - Street 1:1350 FRANKLIN GROVE RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9148
Practice Address - Country:US
Practice Address - Phone:815-285-6749
Practice Address - Fax:815-285-6747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERNORTH DIRECT HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-17
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center