Healthcare Provider Details

I. General information

NPI: 1184225021
Provider Name (Legal Business Name): EVERGREEN HC GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W MAIN ST STE A1
GAYLORD MI
49735-1887
US

IV. Provider business mailing address

403 W MAIN ST STE A
GAYLORD MI
49735-1887
US

V. Phone/Fax

Practice location:
  • Phone: 989-214-1114
  • Fax: 866-410-7843
Mailing address:
  • Phone: 989-214-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER CHURCHES
Title or Position: PRESIDENT
Credential:
Phone: 989-370-3474