Provider Demographics
NPI:1487335709
Name:EVERGREEN LIFE CARE HOMES INC.
Entity type:Organization
Organization Name:EVERGREEN LIFE CARE HOMES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MINAKSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYCHOUDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-483-0196
Mailing Address - Street 1:3092 HANSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-3917
Mailing Address - Country:US
Mailing Address - Phone:408-483-0196
Mailing Address - Fax:559-468-0030
Practice Address - Street 1:542 W BROWNING AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-1802
Practice Address - Country:US
Practice Address - Phone:498-483-0196
Practice Address - Fax:449-468-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility