Healthcare Provider Details

I. General information

NPI: 1447154505
Provider Name (Legal Business Name): EVERGRACE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 CALPHER CT
MATTHEWS NC
28105-4631
US

IV. Provider business mailing address

9715 CALPHER CT
MATTHEWS NC
28105-4631
US

V. Phone/Fax

Practice location:
  • Phone: 704-891-2691
  • Fax:
Mailing address:
  • Phone: 704-891-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMARA CLARK
Title or Position: OWNER
Credential:
Phone: 704-891-2691