Provider Demographics
NPI:1871993949
Name:EVERCARE LLC
Entity type:Organization
Organization Name:EVERCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ADULT CARE DIRECTOR
Authorized Official - Phone:785-477-5321
Mailing Address - Street 1:3401 NE SEWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66616-1651
Mailing Address - Country:US
Mailing Address - Phone:785-286-6388
Mailing Address - Fax:
Practice Address - Street 1:16795 SAY RD
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-9742
Practice Address - Country:US
Practice Address - Phone:785-477-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB089077311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB089077OtherSTATE OF KANSAS LICENSE TO OPERATE CARE HOME