Healthcare Provider Details

I. General information

NPI: 1497665087
Provider Name (Legal Business Name): EVERGREEN INTERACTIVE PROGRAMMING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 NEWFIELD AVE
STAMFORD CT
06905-2919
US

IV. Provider business mailing address

700 CANAL ST
STAMFORD CT
06902-5921
US

V. Phone/Fax

Practice location:
  • Phone: 203-514-7450
  • Fax:
Mailing address:
  • Phone: 203-514-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GABRIEL CORREDOR
Title or Position: FOUNDER
Credential:
Phone: 607-351-9177