Provider Demographics
NPI:1043688088
Name:EVERSHINE CARE, LLC
Entity Type:Organization
Organization Name:EVERSHINE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:NWAOGU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:575-382-5973
Mailing Address - Street 1:4844 CALLE BELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7066
Mailing Address - Country:US
Mailing Address - Phone:575-382-5973
Mailing Address - Fax:
Practice Address - Street 1:4844 CALLE BELLA AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7066
Practice Address - Country:US
Practice Address - Phone:575-382-5973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1T3533315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities