Healthcare Provider Details

I. General information

NPI: 1043147473
Provider Name (Legal Business Name): EVERGREEN FAMILY SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 8TH AVE
GREELEY CO
80631-4009
US

IV. Provider business mailing address

1115 8TH AVE
GREELEY CO
80631-4009
US

V. Phone/Fax

Practice location:
  • Phone: 703-258-4909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MAHAD DARAR
Title or Position: OWNER
Credential:
Phone: 703-258-4909