Provider Demographics
NPI:1699776435
Name:EVERCARE CHOICE, INC.
Entity type:Organization
Organization Name:EVERCARE CHOICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCTIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-725-1101
Mailing Address - Street 1:31 CERONE PLACE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5104
Mailing Address - Country:US
Mailing Address - Phone:845-569-0500
Mailing Address - Fax:845-569-1887
Practice Address - Street 1:31 CERONE PLACE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5104
Practice Address - Country:US
Practice Address - Phone:845-569-0500
Practice Address - Fax:845-569-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
NY01825947302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01825947Medicaid