Provider Demographics
NPI:1285686378
Name:EVERCARE COLLABORATIVE SOLUTIONS INC
Entity Type:Organization
Organization Name:EVERCARE COLLABORATIVE SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-936-5751
Mailing Address - Street 1:601 OFFICE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3232
Mailing Address - Country:US
Mailing Address - Phone:314-336-0945
Mailing Address - Fax:314-336-0949
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:314-336-0945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ919540Medicaid
MNC03298Medicare ID - Type Unspecified
MANG0023Medicare ID - Type Unspecified
OHEV9340291Medicare ID - Type Unspecified
FLK4454Medicare ID - Type Unspecified
GAGRP5068Medicare ID - Type Unspecified
AZ919540Medicaid