Provider Demographics
NPI:1912794819
Name:EVERGREEN PARK AFH
Entity type:Organization
Organization Name:EVERGREEN PARK AFH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-753-2416
Mailing Address - Street 1:17126 SE 29TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5600
Mailing Address - Country:US
Mailing Address - Phone:206-660-1273
Mailing Address - Fax:
Practice Address - Street 1:17126 SE 29TH PL
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-5600
Practice Address - Country:US
Practice Address - Phone:206-660-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home