Healthcare Provider Details

I. General information

NPI: 1235079245
Provider Name (Legal Business Name): EVERBLOOM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N DOBSON RD APT 1045
CHANDLER AZ
85224-6904
US

IV. Provider business mailing address

855 N DOBSON RD APT 1045
CHANDLER AZ
85224-6904
US

V. Phone/Fax

Practice location:
  • Phone: 402-812-1649
  • Fax: 402-812-1649
Mailing address:
  • Phone: 402-812-1649
  • Fax: 402-812-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKEISHA Q ELEM
Title or Position: OWNER
Credential: CNA
Phone: 402-812-1649