Provider Demographics
NPI:1902356603
Name:EVERLASTING SENIOR CARE
Entity Type:Organization
Organization Name:EVERLASTING SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:CALDERON
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-301-6299
Mailing Address - Street 1:2117 CALIFORNIA ST
Mailing Address - Street 2:2109 CALIFORNIA STREET
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5328
Mailing Address - Country:US
Mailing Address - Phone:775-301-6299
Mailing Address - Fax:775-301-6299
Practice Address - Street 1:2117 CALIFORNIA ST
Practice Address - Street 2:2109 CALIFORNIA STREET
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5328
Practice Address - Country:US
Practice Address - Phone:775-301-6299
Practice Address - Fax:775-301-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8615-AGC-0106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV8615-AGC-0Medicaid