Provider Demographics
NPI:1790842284
Name:EVERCARE
Entity Type:Organization
Organization Name:EVERCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTIOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-506-4361
Mailing Address - Street 1:34 CODY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1376
Mailing Address - Country:US
Mailing Address - Phone:410-529-2960
Mailing Address - Fax:
Practice Address - Street 1:6085 MARSHALEE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6023
Practice Address - Country:US
Practice Address - Phone:443-691-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR127624313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility