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Active NPI 1194386193 Organization (Entity Type 2)

Evans Logistic Services Llc

Clinic/Center - Developmental Disabilities • Reddick, FL

Public Directory Information & Medical Disclaimer

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About Evans Logistic Services Llc NPI 1194386193 Summary

Evans Logistic Services Llc is a verified healthcare organization specializing in Clinic/Center - Developmental Disabilities operating in Reddick, FL. Located at 12630 NW 38TH AVE, this facility provides patient care and medical services under National Provider Identifier (NPI) 1194386193.

Administrative operations and authorized compliance are overseen by Terrence Evans (Medicaid Waiver Provider).

The facility is associated with 1 linked healthcare practitioner providing clinical services.

Facility Location & Contact Primary Location

Facility Address

12630 Nw 38th Ave

Reddick, FL 326864067

Telephone 3523612968

Authorized Official Information

Authorized Contact Name

Terrence Evans

Title / Role

Medicaid Waiver Provider

Official Telephone

3523612968

Facility Classifications & Specialties

Clinic/Center - Developmental Disabilities Primary Taxonomy

NUCC Taxonomy Code: 261QD1600X

An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

1 Linked

Terrence Evans NPI 1417411927

Clinic/Center - Developmental Disabilities

Reddick, FL

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

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NPI Profile Active June 21, 2019

NPI status registered as active in NPPES database

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Updated Practice Location June 21, 2019

Registered at 12630 NW 38TH AVE, REDDICK, FL 326864067 (Tel: 3523612968)

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Updated Business Mailing Address June 21, 2019

Registered at 12630 NW 38TH AVE, REDDICK, FL 326864067

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Organization / Clinic Name Updated June 21, 2019

Operating as EVANS LOGISTIC SERVICES LLC

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 21, 2019

Clinic/Center

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Initial NPI Registration & Enumeration June 21, 2019

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1194386193

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: June 21, 2019

Last Update: June 21, 2019

Update or Correct Listing

Mailing Address

12630 Nw 38th Ave

Reddick, FL 326864067

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.