Provider Demographics
NPI:1821350638
Name:EVERGREEN PRIVATE CARE OF HOUSTON LLC
Entity Type:Organization
Organization Name:EVERGREEN PRIVATE CARE OF HOUSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-888-9099
Mailing Address - Street 1:2650 COLLEGE STATION MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-4435
Mailing Address - Country:US
Mailing Address - Phone:404-545-2945
Mailing Address - Fax:855-841-4224
Practice Address - Street 1:16818 N. ELDRIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377
Practice Address - Country:US
Practice Address - Phone:281-320-1856
Practice Address - Fax:281-320-1886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KWJ ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-08
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health