Healthcare Provider Details

I. General information

NPI: 1881557668
Provider Name (Legal Business Name): EVEREST SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 YORK AVE
SAINT PAUL MN
55106-3410
US

IV. Provider business mailing address

1334 YORK AVE
SAINT PAUL MN
55106-3410
US

V. Phone/Fax

Practice location:
  • Phone: 763-843-7079
  • Fax: 763-843-7079
Mailing address:
  • Phone: 763-843-7079
  • Fax: 763-843-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: PA KOU LEE
Title or Position: CEO
Credential:
Phone: 763-843-7079