Provider Demographics
NPI:1558424978
Name:EVERGREEN HOME SERVICES, INC.
Entity Type:Organization
Organization Name:EVERGREEN HOME SERVICES, INC.
Other - Org Name:EVERGREEN IN-HOME CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-389-0006
Mailing Address - Street 1:243 SW SCALEHOUSE LOOP STE 3A
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1280
Mailing Address - Country:US
Mailing Address - Phone:541-389-0006
Mailing Address - Fax:541-389-0906
Practice Address - Street 1:243 SW SCALEHOUSE LOOP STE 3A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1280
Practice Address - Country:US
Practice Address - Phone:541-389-0006
Practice Address - Fax:541-389-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2012251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR524565Medicaid