Provider Demographics
NPI:1871853515
Name:EVERGREEN HOMECARE AT BOCA
Entity Type:Organization
Organization Name:EVERGREEN HOMECARE AT BOCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:ESTEFANIA
Authorized Official - Last Name:HUIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-470-5159
Mailing Address - Street 1:4400 N FEDERAL HWY
Mailing Address - Street 2:SUITE 210-48
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5187
Mailing Address - Country:US
Mailing Address - Phone:561-922-9726
Mailing Address - Fax:561-922-9728
Practice Address - Street 1:4400 N FEDERAL HWY
Practice Address - Street 2:SUITE 210-48
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5187
Practice Address - Country:US
Practice Address - Phone:561-922-9726
Practice Address - Fax:561-922-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-28
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health