MEDICARE: EVANS HEALTH CARE ASSOCIATES 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	314000000X	Skilled Nursing Facility	SNF130470992	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962457333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS HEALTH CARE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	3735 EVANS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9302
Country	:	US
Telephone Number	:	239-277-3977
Fax Number	:	239-277-1955

Provider Business Practice Location Address
First Line	:	3735 EVANS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9302
Country	:	US
Telephone Number	:	239-277-3977
Fax Number	:	239-277-1955

Authorized Official
Title or Position	:	MANAGER
Name	:	WILLIAM B. BOYD
Credential	:
Telephone Number	:	239-277-3977

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/19/2013

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