Healthcare Provider Details

I. General information

NPI: 1255260600
Provider Name (Legal Business Name): EVERGREEN CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11004A DOORSTONE DR
LATHAM NY
12110-3770
US

IV. Provider business mailing address

11004A DOORSTONE DR
LATHAM NY
12110-3770
US

V. Phone/Fax

Practice location:
  • Phone: 307-289-2158
  • Fax:
Mailing address:
  • Phone: 812-247-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: RIZWAN A SHERDIL
Title or Position: OWNER
Credential:
Phone: 812-247-5977