Provider Demographics
NPI:1710391990
Name:EVERGREEN HOME HEALTH CARE AGENCY INC.
Entity Type:Organization
Organization Name:EVERGREEN HOME HEALTH CARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-459-8301
Mailing Address - Street 1:13 LAKE VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-5419
Mailing Address - Country:US
Mailing Address - Phone:848-459-8301
Mailing Address - Fax:888-664-5617
Practice Address - Street 1:13 LAKE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-5419
Practice Address - Country:US
Practice Address - Phone:848-459-8301
Practice Address - Fax:888-664-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0187200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health