1871993949 NPI number — EVERCARE LLC

Table of content: (NPI 1871993949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871993949 NPI number — EVERCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERCARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FOUNDATION HOUSE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871993949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 NE SEWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66616-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-286-6388
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16795 SAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAMEGO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66547-9742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-477-5321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
EVERSON
Authorized Official First Name:
KELLIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
785-477-5321

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  B089077 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B089077 . This is a "STATE OF KANSAS LICENSE TO OPERATE CARE HOME" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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