Provider Demographics
NPI:1881677581
Name:EVERGREEN MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:EVERGREEN MEDICAL CENTER LLC
Other - Org Name:EVERGREEN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-578-2480
Mailing Address - Street 1:308 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401
Mailing Address - Country:US
Mailing Address - Phone:251-578-6800
Mailing Address - Fax:251-578-0252
Practice Address - Street 1:308 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401
Practice Address - Country:US
Practice Address - Phone:251-578-6800
Practice Address - Fax:251-578-0252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10419163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALGIL7106AMedicaid
AL51043109OtherBC BS
AL017106Medicare Oscar/Certification