Healthcare Provider Details

I. General information

NPI: 1831683572
Provider Name (Legal Business Name): EVER MERCY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18412 W MISSION LN
WADDELL AZ
85355-4303
US

IV. Provider business mailing address

18412 W MISSION LN
WADDELL AZ
85355-4303
US

V. Phone/Fax

Practice location:
  • Phone: 623-666-3895
  • Fax: 623-321-1206
Mailing address:
  • Phone: 623-666-3895
  • Fax: 623-321-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number08035
License Number StateAZ

VIII. Authorized Official

Name: JOHN OMIJIE
Title or Position: COODIRECTOR
Credential:
Phone: 623-326-3327