Provider Demographics
NPI:1033401500
Name:EVERGREEN ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:EVERGREEN ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VINIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-735-9604
Mailing Address - Street 1:6521 CLEARHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4017
Mailing Address - Country:US
Mailing Address - Phone:972-735-9604
Mailing Address - Fax:972-735-9602
Practice Address - Street 1:6521 CLEARHAVEN CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4017
Practice Address - Country:US
Practice Address - Phone:972-735-9604
Practice Address - Fax:972-735-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care