Provider Demographics
NPI:1114654407
Name:EVERGREEN CARE SOLUTION LLC
Entity Type:Organization
Organization Name:EVERGREEN CARE SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAKU
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:617-379-0496
Mailing Address - Street 1:325 ELLINGTON BLVD # 117
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4591
Mailing Address - Country:US
Mailing Address - Phone:617-379-0496
Mailing Address - Fax:
Practice Address - Street 1:325 ELLINGTON BLVD # 117
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-4591
Practice Address - Country:US
Practice Address - Phone:336-254-4619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty