Provider Demographics
NPI:1558082859
Name:BUTTERFLIES 4 EVELYN LLC
Entity Type:Organization
Organization Name:BUTTERFLIES 4 EVELYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:SHAGLADYS
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-230-1228
Mailing Address - Street 1:PO BOX 6193
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27894-6193
Mailing Address - Country:US
Mailing Address - Phone:252-363-6280
Mailing Address - Fax:
Practice Address - Street 1:502 JORDAN ST SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4827
Practice Address - Country:US
Practice Address - Phone:252-230-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1679207245Medicaid