Provider Demographics
NPI:1902393564
Name:EVERSHINE CARE LLC
Entity Type:Organization
Organization Name:EVERSHINE CARE LLC
Other - Org Name:EVERSHINE CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAOGU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:443-854-4727
Mailing Address - Street 1:4844 CALLE BELLA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7066
Mailing Address - Country:US
Mailing Address - Phone:575-382-5973
Mailing Address - Fax:575-541-3635
Practice Address - Street 1:4681 JOSEPH H LN
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-9599
Practice Address - Country:US
Practice Address - Phone:575-382-5973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERSHINE CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness