Healthcare Provider Details

I. General information

NPI: 1356966907
Provider Name (Legal Business Name): EVINS CREMATION &FUNERAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 CROWS LANDING RD
MODESTO CA
95358-9419
US

IV. Provider business mailing address

3637 CROWS LANDING RD
MODESTO CA
95358-9419
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-3846
  • Fax: 209-409-3339
Mailing address:
  • Phone: 209-522-3846
  • Fax: 209-409-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State

VIII. Authorized Official

Name: MS. KAEN SIBLEY
Title or Position: OPERATIONS COORDINATOR
Credential: NOTARY PUBLC
Phone: 209-522-3846