Provider Demographics
NPI:1932582715
Name:EVERGREEN ADULT MEDICAL DAY CARE
Entity Type:Organization
Organization Name:EVERGREEN ADULT MEDICAL DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JADEN
Authorized Official - Middle Name:JOON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-527-1100
Mailing Address - Street 1:9290 GAITHER RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1420
Mailing Address - Country:US
Mailing Address - Phone:301-527-1100
Mailing Address - Fax:301-658-3240
Practice Address - Street 1:9290 GAITHER RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1420
Practice Address - Country:US
Practice Address - Phone:301-527-1100
Practice Address - Fax:301-658-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15011A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care