Provider Demographics
NPI:1205503117
Name:EVERGREEN HOME CARE
Entity type:Organization
Organization Name:EVERGREEN HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:614-592-8678
Mailing Address - Street 1:2852 BOUDINOT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2461
Mailing Address - Country:US
Mailing Address - Phone:614-592-8678
Mailing Address - Fax:
Practice Address - Street 1:2852 BOUDINOT AVE STE 202
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2461
Practice Address - Country:US
Practice Address - Phone:614-592-8678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH872337271OtherIRS