MEDICARE: EVANS ELECTRIFYING ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1255527537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS ELECTRIFYING ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	5528 GREEN WILLOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1646
Country	:	US
Telephone Number	:	702-655-4177
Fax Number	:	702-395-5247

Provider Business Practice Location Address
First Line	:	5528 GREEN WILLOW ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1646
Country	:	US
Telephone Number	:	702-655-4177
Fax Number	:	702-395-5247

Authorized Official
Title or Position	:	FOUNDER/PRESIDENT/OWNER
Name	:	MS. BOBBYE EVANS
Credential	:	MBA, RA,
Telephone Number	:	702-655-4177

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	07/21/2022

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