=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629893359
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERCARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13944 EDGEWOOD AVE UNIT 212
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55378-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-688-9365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13944 EDGEWOOD AVE UNIT 212
-----------------------------------------------------
City | SAVAGE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55378-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-688-9365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | IDRIS AHMED ABDULLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-688-9365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------