Provider Demographics
NPI:1124593074
Name:EVERGREEN CHOICE LLC
Entity Type:Organization
Organization Name:EVERGREEN CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-260-6250
Mailing Address - Street 1:1979 MARCUS AVE STE C115
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1126
Mailing Address - Country:US
Mailing Address - Phone:718-260-6250
Mailing Address - Fax:
Practice Address - Street 1:1177 6TH AVE # 5140
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2714
Practice Address - Country:US
Practice Address - Phone:718-260-6250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health