Healthcare Provider Details

I. General information

NPI: 1548172059
Provider Name (Legal Business Name): EVERGRACE HOME CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E MARTIN ST STE 307
RALEIGH NC
27601-3013
US

IV. Provider business mailing address

6321 PERRY CREEK RD
RALEIGH NC
27616-4348
US

V. Phone/Fax

Practice location:
  • Phone: 919-601-4220
  • Fax:
Mailing address:
  • Phone: 919-601-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ASHICA TYLER
Title or Position: OWNER
Credential:
Phone: 919-601-4220