Healthcare Provider Details

I. General information

NPI: 1073430997
Provider Name (Legal Business Name): EVELYN CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CAMPBELL DR
CHERAW SC
29520-3706
US

IV. Provider business mailing address

3644 ANGELUS RD
CHESTERFIELD SC
29709-5340
US

V. Phone/Fax

Practice location:
  • Phone: 860-308-9370
  • Fax:
Mailing address:
  • Phone: 860-308-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number107751227
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: