Provider Demographics
NPI:1659873552
Name:EVERGREEN CARE LLC
Entity Type:Organization
Organization Name:EVERGREEN CARE LLC
Other - Org Name:MRS.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:C
Authorized Official - Last Name:OJIAKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-706-5109
Mailing Address - Street 1:16609 PLEASANT COLONY DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8802
Mailing Address - Country:US
Mailing Address - Phone:240-706-5109
Mailing Address - Fax:
Practice Address - Street 1:16609 PLEASANT COLONY DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8802
Practice Address - Country:US
Practice Address - Phone:240-706-5109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care