Provider Demographics
NPI:1932589165
Name:EVERGREEN BAY FAMILY CARE INC
Entity type:Organization
Organization Name:EVERGREEN BAY FAMILY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-532-3122
Mailing Address - Street 1:655 MIRAMONTES ST
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1945
Mailing Address - Country:US
Mailing Address - Phone:650-532-3122
Mailing Address - Fax:
Practice Address - Street 1:655 MIRAMONTES ST
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1945
Practice Address - Country:US
Practice Address - Phone:650-532-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health