Provider Demographics
NPI:1851831465
Name:EVER WELL HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:EVER WELL HEALTH SYSTEMS, LLC
Other - Org Name:DELTA AT THE PORTSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:GROBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-070-0989
Mailing Address - Street 1:391 FRONT ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-1553
Mailing Address - Country:US
Mailing Address - Phone:802-242-0135
Mailing Address - Fax:
Practice Address - Street 1:1950 E SONORA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-6364
Practice Address - Country:US
Practice Address - Phone:805-242-0135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness