Evans Elderly Residential Care LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

366426751 Issued in CA

Legal business name

EVANS ELDERLY RESIDENTIAL CARE LLC

Practice address

13947 Castille St
Victorville, CA 92392-5508

Phone

(760) 261-4241

NPI assigned

Jun 17, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly EvansNPI 1407211352

Title

Administrator

Phone

(760) 261-4241

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Evans

  • Home Health Aide
  • Victorville, CA
  • NPI 1407211352
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1972953156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13947 CASTILLE ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923925508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13947 CASTILLE ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923925508",
            "telephone_number": "760-261-4241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS ELDERLY RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-17",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "760-261-4241"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "366426751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mayra Estrada
• Monica Estrada
• Melisa Etchegoyen
• Hailey Allison Eubanks, RADT
• Euphoria Nursing Services, Inc.
• Heather Lynn Evans
• Katrina Marie Evans
• Kelly Evans
• Mecca Dionne Evans
• Stevevonna R Evans

• Assisted Living Facility in Victorville, CA
• Providers in Victorville, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.