NPIMap

Organization Active NPI

Evernorth Direct Health LLC

Doing business as Mohawk Healthy Life Center at Antioch

  • Non-Pharmacy Dispensing Site
  • Dalton, GA
National Provider Identifier
1609171917
Registry record updated May 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
RN213704 Issued in GA
Legal business name
EVERNORTH DIRECT HEALTH LLC
Doing business as
Mohawk Healthy Life Center at Antioch
Practice address
2001 Antioch Rd
Dalton, GA 30721-4622
Phone
(706) 275-7660
NPI assigned
Jan 18, 2011
Last updated
May 3, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 3, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X RN213704 GA Primary

Addresses

Primary practice location

2001 Antioch Rd
Dalton, GA 30721-4622

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701

Other names 1

  • MOHAWK HEALTHY LIFE CENTER AT ANTIOCH Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2058393Healthy Life Center2001 Antioch Road, Dalton, GA 30721Certificate of waiverJul 28, 2028

National Provider Directory

National Provider Directory
Tax ID family
Evernorth Direct Health LLC102 organizations share this tax ID, including this one
Part of
Medvantx Inc

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620000000000",
    "number": "1609171917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 ANTIOCH RD",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307214622",
            "telephone_number": "706-275-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERNORTH DIRECT HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2011-01-18",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "GA",
            "license": "RN213704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOHAWK HEALTHY LIFE CENTER AT ANTIOCH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MOHAWK HEALTHY LIFE CENTER AT ANTIOCH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.