Healthcare Provider Details

I. General information

NPI: 1316707565
Provider Name (Legal Business Name): EVERGREEN HEALTHCARE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 E MAIN ST UNIT 2-2A
WESTMINSTER MD
21157-5523
US

IV. Provider business mailing address

12815 WILLOW MARSH LN # 410
BOWIE MD
20720-4691
US

V. Phone/Fax

Practice location:
  • Phone: 301-806-1796
  • Fax: 301-459-3000
Mailing address:
  • Phone: 301-806-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: GASBY AYOH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 301-806-1796