Provider Demographics
NPI:1659702389
Name:EVERGREEN HOME CARE & HOSPICE INC
Entity Type:Organization
Organization Name:EVERGREEN HOME CARE & HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SELICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-293-7072
Mailing Address - Street 1:3756 SANTA ROSALIA DR STE 520B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3656
Mailing Address - Country:US
Mailing Address - Phone:323-293-7072
Mailing Address - Fax:323-293-7123
Practice Address - Street 1:3756 SANTA ROSALIA DR STE 520B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3656
Practice Address - Country:US
Practice Address - Phone:323-293-7072
Practice Address - Fax:323-293-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based