Provider Demographics
NPI:1952797813
Name:EVERGREENS HOME CARE LLC
Entity Type:Organization
Organization Name:EVERGREENS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-541-0556
Mailing Address - Street 1:4508 SHAW FARM CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9382
Mailing Address - Country:US
Mailing Address - Phone:336-541-0556
Mailing Address - Fax:
Practice Address - Street 1:4508 SHAW FARM CIR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-9382
Practice Address - Country:US
Practice Address - Phone:336-541-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care