Provider Demographics
NPI:1497276588
Name:EVERGREEN SENIOR DAYCARE CENTER
Entity Type:Organization
Organization Name:EVERGREEN SENIOR DAYCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-288-9878
Mailing Address - Street 1:949 59TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:949 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4810
Practice Address - Country:US
Practice Address - Phone:917-288-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization