Healthcare Provider Details

I. General information

NPI: 1154629012
Provider Name (Legal Business Name): EVERGREEN ADULT DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LAWRENCE ST ATTN: BUSINESS OFFICE
SARATOGA SPRINGS NY
12866-1346
US

IV. Provider business mailing address

131 LAWRENCE STREET ATTENTION: BUSINESS OFFICE
SARATOGA SPRINGS NY
12866
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-3600
  • Fax: 518-587-2930
Mailing address:
  • Phone: 518-587-3600
  • Fax: 518-587-2930

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: SHELLY AMATO
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA, MBA, LNHA
Phone: 518-691-1416