Provider Demographics
NPI:1154049856
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 1:7834 C F HAWN FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-6529
Mailing Address - Country:US
Mailing Address - Phone:214-309-3438
Mailing Address - Fax:214-309-3431
Practice Address - Street 1:7834 C F HAWN FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-6529
Practice Address - Country:US
Practice Address - Phone:214-309-3438
Practice Address - Fax:214-309-3431
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERNORTH DIRECT HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center