Healthcare Provider Details

I. General information

NPI: 1336683366
Provider Name (Legal Business Name): EVERCARE FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 5TH ST SUITE 101
SANTA FE NM
87505-5403
US

IV. Provider business mailing address

1911 5TH ST SUITE 101
SANTA FE NM
87505-5403
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-8301
  • Fax: 505-780-5418
Mailing address:
  • Phone: 505-780-8301
  • Fax: 505-780-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberCNP00488
License Number StateNM

VIII. Authorized Official

Name: MRS. KAREN C ODAY
Title or Position: OWNER
Credential: CFNP
Phone: 505-780-8301