Provider Demographics
NPI:1427945765
Name:EVERGRACE HOME SERVICES LLC
Entity type:Organization
Organization Name:EVERGRACE HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MISS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOUINA
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-400-6357
Mailing Address - Street 1:5710 NW 54TH WAY
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2517
Mailing Address - Country:US
Mailing Address - Phone:917-400-6357
Mailing Address - Fax:
Practice Address - Street 1:5710 NW 54TH WAY
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2517
Practice Address - Country:US
Practice Address - Phone:917-400-6357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care