Provider Demographics
NPI:1467254235
Name:EVERGREEN HEALTH CARE & GROUP HOME LLC
Entity type:Organization
Organization Name:EVERGREEN HEALTH CARE & GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELVINE
Authorized Official - Middle Name:NKONGHO
Authorized Official - Last Name:AYUK
Authorized Official - Suffix:
Authorized Official - Credentials:DELVINE AYUK
Authorized Official - Phone:943-238-3539
Mailing Address - Street 1:7147 MOUNT ZION CIR APT 1203
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3330
Mailing Address - Country:US
Mailing Address - Phone:470-894-0009
Mailing Address - Fax:
Practice Address - Street 1:7147 MOUNT ZION CIR APT 1203
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3330
Practice Address - Country:US
Practice Address - Phone:943-238-3539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility