Provider Demographics
NPI:1629317367
Name:EVERGREEN ADULT DAY CARE, LLC
Entity Type:Organization
Organization Name:EVERGREEN ADULT DAY CARE, LLC
Other - Org Name:EVERGREEN ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-991-8527
Mailing Address - Street 1:335 LANCASTER CT
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6222
Mailing Address - Country:US
Mailing Address - Phone:732-991-8527
Mailing Address - Fax:732-947-3001
Practice Address - Street 1:33 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2166
Practice Address - Country:US
Practice Address - Phone:732-991-8527
Practice Address - Fax:732-947-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care