Provider Demographics
NPI:1720626484
Name:EVERGREEN HEALTH & WELLNESS INC.
Entity type:Organization
Organization Name:EVERGREEN HEALTH & WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XIUZHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-731-6185
Mailing Address - Street 1:222 W 26TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4099
Mailing Address - Country:US
Mailing Address - Phone:312-731-6185
Mailing Address - Fax:
Practice Address - Street 1:222 W 26TH ST STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4099
Practice Address - Country:US
Practice Address - Phone:312-763-6192
Practice Address - Fax:312-277-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care