Healthcare Provider Details

I. General information

NPI: 1487221107
Provider Name (Legal Business Name): EVERGREEN SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 MILLWOOD AVE
WINCHESTER VA
22601-4453
US

IV. Provider business mailing address

380 MILLWOOD AVE
WINCHESTER VA
22601-4453
US

V. Phone/Fax

Practice location:
  • Phone: 540-667-7010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LIEBERMAN
Title or Position: DIRECTOR OF FINANCIAL OPERATIONS
Credential:
Phone: 646-275-4510