Healthcare Provider Details

I. General information

NPI: 1326978487
Provider Name (Legal Business Name): EVERGREEN CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7732 SHOUP AVENUE
CANOGA PARK CA
91304-2436
US

IV. Provider business mailing address

7732 SHOUP AVENUE
CANOGA PARK CA
91304-2436
US

V. Phone/Fax

Practice location:
  • Phone: 310-266-0779
  • Fax: 310-271-4010
Mailing address:
  • Phone: 310-266-0779
  • Fax: 310-271-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT NEMAN
Title or Position: OWNER
Credential:
Phone: 310-226-0779