Healthcare Provider Details

I. General information

NPI: 1437075082
Provider Name (Legal Business Name): EVERGRACE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 SW WATERWAY LN
PORT ST LUCIE FL
34987-2494
US

IV. Provider business mailing address

10450 SW WATERWAY LN
PORT ST LUCIE FL
34987-2494
US

V. Phone/Fax

Practice location:
  • Phone: 772-249-1634
  • Fax:
Mailing address:
  • Phone: 772-249-1634
  • Fax:

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: ELIZABETH JOSEPH ORTEGA
Title or Position: ADMINISTRATOR
Credential: DMD
Phone: 689-250-7795