Provider Demographics
NPI:1215936539
Name:EVERGREEN HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:EVERGREEN HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:724-854-1839
Mailing Address - Street 1:417 MALLEABLE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1936
Mailing Address - Country:US
Mailing Address - Phone:724-347-7344
Mailing Address - Fax:724-347-7345
Practice Address - Street 1:417 MALLEABLE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-1936
Practice Address - Country:US
Practice Address - Phone:724-347-7344
Practice Address - Fax:724-347-7345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH78111385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019703400003Medicaid
OH2437643Medicaid