Provider Demographics
NPI:1144591116
Name:EVERGREEN CARE, INC.
Entity Type:Organization
Organization Name:EVERGREEN CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JWA-HEE
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-402-4299
Mailing Address - Street 1:17215 STUDEBAKER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2548
Mailing Address - Country:US
Mailing Address - Phone:562-402-4299
Mailing Address - Fax:562-402-4290
Practice Address - Street 1:17215 STUDEBAKER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2524
Practice Address - Country:US
Practice Address - Phone:562-402-4299
Practice Address - Fax:562-402-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care