Individual
MR. WILLIAM W EVERLY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CARE PROVIDER
Contact information
Practice address
30051 SWAN POINT DR, CANYON LAKE, CA 92587-7407
(949) 212-8851
(949) 481-3197
Mailing address
30051 SWAN POINT DR, CANYON LAKE, CA 92587-7407
(949) 212-8851
(949) 481-3197
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
002919919
CA
374U00000X
Home Health Aide
Primary
002919919
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002919919
—
CA
Enumeration date
02/10/2023
Last updated
02/10/2023
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