Provider Demographics
NPI:1346607959
Name:EVERLASTING FAMILY HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:EVERLASTING FAMILY HOME CARE SERVICES LLC
Other - Org Name:EVERLASTING FAMILY HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUVENSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN DENIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-907-6056
Mailing Address - Street 1:2722 OKLAHOMA ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-4212
Mailing Address - Country:US
Mailing Address - Phone:561-907-6956
Mailing Address - Fax:561-513-9365
Practice Address - Street 1:2722 OKLAHOMA ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-4212
Practice Address - Country:US
Practice Address - Phone:561-907-6956
Practice Address - Fax:561-513-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12890310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016168600Medicaid