Provider Demographics
NPI:1326720806
Name:EVERGREEN NURSING HEALTH, LLC
Entity Type:Organization
Organization Name:EVERGREEN NURSING HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-338-9970
Mailing Address - Street 1:7440 HERITAGE VILLAGE PLZ STE 102
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3081
Mailing Address - Country:US
Mailing Address - Phone:703-268-0227
Mailing Address - Fax:
Practice Address - Street 1:7440 HERITAGE VILLAGE PLZ STE 102
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3081
Practice Address - Country:US
Practice Address - Phone:703-268-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care