MEDICARE: EVERCARE HOSPICE, 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	251G00000X	Community Based Hospice Care Agency	0158HSP	OH

General Provider Information

NPI Number	:	1295000628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERCARE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	9900 BREN RD E
Second Line	:	SUITE 100
City	:	MINNETONKA
State	:	MN
Zip	:	55343-9664
Country	:	US
Telephone Number	:	303-714-2377
Fax Number	:	303-714-2396

Provider Business Practice Location Address
First Line	:	2140 POGUE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3234
Country	:	US
Telephone Number	:	513-682-4040
Fax Number	:	888-810-8182

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	PATRICIA ALYCE FORD
Credential	:
Telephone Number	:	303-714-2377

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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