MEDICARE: EVENA'S HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1467311803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVENA'S HOME CARE LLC

Provider Business Mailing Address
First Line	:	6765 NW DAFFODIL LN
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6765 NW DAFFODIL LN
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1416
Country	:	US
Telephone Number	:	786-715-7539
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EVENA DUFORT
Credential	:
Telephone Number	:	786-715-7539

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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