Provider Demographics
NPI:1114347119
Name:THE EKG GROUP LLC
Entity Type:Organization
Organization Name:THE EKG GROUP LLC
Other - Org Name:EVERGREEN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:WONG
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-617-6728
Mailing Address - Street 1:14819 N CAVE CREEK RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4909
Mailing Address - Country:US
Mailing Address - Phone:602-688-8648
Mailing Address - Fax:602-218-4331
Practice Address - Street 1:14819 N CAVE CREEK RD
Practice Address - Street 2:SUITE 18
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4909
Practice Address - Country:US
Practice Address - Phone:602-688-8648
Practice Address - Fax:602-218-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA6561251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health