MEDICARE: EVEREST SERVICE CORPORATION

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1881557668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVEREST SERVICE CORPORATION

Provider Business Mailing Address
First Line	:	1334 YORK AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-3410
Country	:	US
Telephone Number	:	763-843-7079
Fax Number	:	763-843-7079

Provider Business Practice Location Address
First Line	:	1334 YORK AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-3410
Country	:	US
Telephone Number	:	763-843-7079
Fax Number	:	763-843-7079

Authorized Official
Title or Position	:	CEO
Name	:	PA KOU LEE
Credential	:
Telephone Number	:	763-843-7079

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “EVEREST SERVICE CORPORATION ” Practice Location

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