MEDICARE: EVERGRACE HOME SERVICES LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1427945765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGRACE HOME SERVICES LLC

Provider Business Mailing Address
First Line	:	5710 NW 54TH WAY
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2517
Country	:	US
Telephone Number	:	917-400-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	5710 NW 54TH WAY
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33319-2517
Country	:	US
Telephone Number	:	917-400-6357
Fax Number	:

Authorized Official
Title or Position	:	MISS
Name	:	MARY LOUINA LOUIS
Credential	:
Telephone Number	:	917-400-6357

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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Directions to “EVERGRACE HOME SERVICES LLC ” Practice Location

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