Provider Demographics
NPI:1841577640
Name:EVERCARE INC
Entity Type:Organization
Organization Name:EVERCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ENECHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-940-4733
Mailing Address - Street 1:PO BOX 90014
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-0014
Mailing Address - Country:US
Mailing Address - Phone:863-940-4733
Mailing Address - Fax:863-940-4734
Practice Address - Street 1:1611 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3107
Practice Address - Country:US
Practice Address - Phone:863-940-4733
Practice Address - Fax:863-940-4734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
FLPH256443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004275800Medicaid
2132624OtherPK