Healthcare Provider Details

I. General information

NPI: 1427945765
Provider Name (Legal Business Name): EVERGRACE HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 NW 54TH WAY
TAMARAC FL
33319-2517
US

IV. Provider business mailing address

5710 NW 54TH WAY
TAMARAC FL
33319-2517
US

V. Phone/Fax

Practice location:
  • Phone: 917-400-6357
  • Fax:
Mailing address:
  • Phone: 917-400-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY LOUINA LOUIS
Title or Position: MISS
Credential:
Phone: 917-400-6357