Provider Demographics
NPI:1639876378
Name:EVERGREEN RIDGE CARE,LLC
Entity Type:Organization
Organization Name:EVERGREEN RIDGE CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SENAIT
Authorized Official - Middle Name:BELETE
Authorized Official - Last Name:WOLDEYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-816-2470
Mailing Address - Street 1:13412 60TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9461
Mailing Address - Country:US
Mailing Address - Phone:206-816-2470
Mailing Address - Fax:425-948-7977
Practice Address - Street 1:13412 60TH DR SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9461
Practice Address - Country:US
Practice Address - Phone:206-816-2470
Practice Address - Fax:425-948-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty