Healthcare Provider Details

I. General information

NPI: 1790060747
Provider Name (Legal Business Name): EMBRACIVE HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 LINDBERG BAY DRIVE CYRIL E. KING AIRPORT
ST. THOMAS VI
00802-5945
US

IV. Provider business mailing address

PO BOX 7565
ST THOMAS VI
00801-0565
US

V. Phone/Fax

Practice location:
  • Phone: 866-437-7589
  • Fax: 888-505-5087
Mailing address:
  • Phone: 866-437-7589
  • Fax: 888-505-5087

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 Code3416A0800X
TaxonomyAir Ambulance
License Number1-13182-1L
License Number StateVI

VIII. Authorized Official

Name: MR. LISLE ANTHONY EVELYN JR.
Title or Position: PRESIDENT/ CEO
Credential:
Phone: 866-437-7589