Provider Demographics
NPI:1215192117
Name:EVERGREEN HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:EVERGREEN HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:ESTACIO
Authorized Official - Last Name:CU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-777-1991
Mailing Address - Street 1:9788 CLAREWOOD DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5141
Mailing Address - Country:US
Mailing Address - Phone:713-777-1991
Mailing Address - Fax:713-777-1980
Practice Address - Street 1:9788 CLAREWOOD DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5141
Practice Address - Country:US
Practice Address - Phone:713-777-1991
Practice Address - Fax:713-777-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 3747P1801X
TX012096251E00000X
TX014674251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025442OtherSTATE CONTRACT