Sign up – Health Care Organizationadmin_eh12025-10-08T15:23:15-07:00

Sign up below to join Everlight Health’s Network of Health Care Organizations

Questions before you sign up? Contact us.

Contact us for a Consultation

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Company Name(Required)

Primary Contact Name(Required)

First Last

Phone(Required)

Email(Required)

Enter Email Confirm Email

Website

Care Organization Type(Required)

Select One. Only only Entity type is allowed per NPI.

Home Health Agency

Hospice

Assisted Living Facility

NPI Number(Required)

Physical Therapist Rate(Required)

Please enter a number greater than or equal to 60.

Physical Therapist Assistant Rate(Required)

Please enter a number greater than or equal to 60.

Occupational Therapist Rate(Required)

Please enter a number greater than or equal to 60.

Speech / Language Pathologist Rate(Required)

Please enter a number greater than or equal to 60.

Registered Nurse Rate(Required)

Please enter a number greater than or equal to 60.

Licensed Vocational Nurse Rate(Required)

Please enter a number greater than or equal to 60.

Primary Address(Required)

Street Address Address Line 2 City State ZIP Code

Mailing Address

Same as Primary