=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558728741
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVA HOMECARE AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2016
-----------------------------------------------------
Last Update Date | 01/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10470 QUEENS BLVD SUITE 503
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-3638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-896-9016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10470 QUEENS BLVD SUITE 503
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-3638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. YIJIA ZHANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-896-9016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2164L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------