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General NPI Number Information
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NPI Number | 1962712950
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Entity Type | Organization
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Legal Business Name | EVERCARE, LLC
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 410 RICHARDS AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3635
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Country | US
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Telephone | 307-660-6849
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Fax |
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Provider Business Mailing Address
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Address Line | 410 RICHARDS AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3635
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Country | US
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Telephone | 307-660-6849
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | HEIDI RENEE KNIGHT
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Credential | RN
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Telephone | 307-660-6849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 21260
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 21260
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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