Healthcare Provider Details

I. General information

NPI: 1114654407
Provider Name (Legal Business Name): EVERGREEN CARE SOLUTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ELLINGTON BLVD # 117
GAITHERSBURG MD
20878-4591
US

IV. Provider business mailing address

325 ELLINGTON BLVD # 117
GAITHERSBURG MD
20878-4591
US

V. Phone/Fax

Practice location:
  • Phone: 336-254-4619
  • Fax:
Mailing address:
  • Phone: 617-379-0496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADAKU ANIKE
Title or Position: PRESIDENT
Credential: NP
Phone: 617-379-0496