Provider Demographics
NPI:1639241219
Name:EVERGREEN HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:EVERGREEN HEALTH SERVICES, INC.
Other - Org Name:BEACH HOME HEALTH CARE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELTERBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-625-8860
Mailing Address - Street 1:6510 TOWN CENTER DR
Mailing Address - Street 2:SUITE# B
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4822
Mailing Address - Country:US
Mailing Address - Phone:248-625-8860
Mailing Address - Fax:248-625-8858
Practice Address - Street 1:6510 TOWN CENTER DR
Practice Address - Street 2:SUITE# B
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4822
Practice Address - Country:US
Practice Address - Phone:248-625-8860
Practice Address - Fax:248-625-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
237675Medicare Oscar/Certification