Provider Demographics
NPI:1346449725
Name:EVERGREEN LIVING HOME INC.
Entity Type:Organization
Organization Name:EVERGREEN LIVING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SONG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-779-5588
Mailing Address - Street 1:41 UPPER SAW BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8196
Mailing Address - Country:US
Mailing Address - Phone:828-665-7888
Mailing Address - Fax:
Practice Address - Street 1:41 UPPER SAW BRANCH RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-8196
Practice Address - Country:US
Practice Address - Phone:828-665-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility