Healthcare Provider Details

I. General information

NPI: 1053220780
Provider Name (Legal Business Name): EVERGREEN MOBILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 138TH ST S # B
TACOMA WA
98444-4726
US

IV. Provider business mailing address

418 138TH ST S # B
TACOMA WA
98444-4726
US

V. Phone/Fax

Practice location:
  • Phone: 253-737-9517
  • Fax:
Mailing address:
  • Phone: 253-737-9517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL

VIII. Authorized Official

Name: LUDMILA VICKERY
Title or Position: OWNER
Credential:
Phone: 253-737-9517