Provider Demographics
NPI:1336683366
Name:EVERCARE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:EVERCARE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ODAY
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:505-780-8301
Mailing Address - Street 1:1911 5TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5403
Mailing Address - Country:US
Mailing Address - Phone:505-780-8301
Mailing Address - Fax:505-780-5418
Practice Address - Street 1:1911 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5403
Practice Address - Country:US
Practice Address - Phone:505-780-8301
Practice Address - Fax:505-780-5418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00488261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center