Provider Demographics
NPI:1104946508
Name:EVERGREEN HOME CARE LLC
Entity type:Organization
Organization Name:EVERGREEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PURVI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-291-5806
Mailing Address - Street 1:1663 STEPHENSON HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2169
Mailing Address - Country:US
Mailing Address - Phone:248-291-5806
Mailing Address - Fax:248-291-6847
Practice Address - Street 1:1663 STEPHENSON HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2169
Practice Address - Country:US
Practice Address - Phone:248-291-5806
Practice Address - Fax:248-291-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health