Provider Demographics
NPI:1437757317
Name:SC EVERGREEN HEALTH MANAGEMENT INC.
Entity Type:Organization
Organization Name:SC EVERGREEN HEALTH MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-382-9460
Mailing Address - Street 1:8408 GARVEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2681
Mailing Address - Country:US
Mailing Address - Phone:626-382-9460
Mailing Address - Fax:
Practice Address - Street 1:8408 GARVEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2681
Practice Address - Country:US
Practice Address - Phone:626-382-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care