Healthcare Provider Details

I. General information

NPI: 1003553843
Provider Name (Legal Business Name): EVERGREEN SENIOR DAYCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14222 37TH AVE
FLUSHING NY
11354-4103
US

IV. Provider business mailing address

14222 37TH AVE
FLUSHING NY
11354-4103
US

V. Phone/Fax

Practice location:
  • Phone: 718-799-0423
  • Fax:
Mailing address:
  • Phone:
  • 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: WEI GUO
Title or Position: DIRECTION
Credential:
Phone: 917-288-9878