Healthcare Provider Details

I. General information

NPI: 1104261833
Provider Name (Legal Business Name): EVERAH ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CHESTERFIELD DR
NEW CASTLE DE
19720-1220
US

IV. Provider business mailing address

109 CHESTERFIELD DR
NEW CASTLE DE
19720-1220
US

V. Phone/Fax

Practice location:
  • Phone: 302-275-6879
  • Fax:
Mailing address:
  • Phone: 302-275-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number77182
License Number StateCA

VIII. Authorized Official

Name: MRS. CICELY RICHEL EVERSON
Title or Position: OWNER
Credential: CNPM
Phone: 302-275-6879