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General NPI Number Information
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NPI Number | 1093593048
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOMECARE LLC
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 8156 RAINWATER CIR
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City | MANASSAS
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State | VA
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Zip | 20111-5231
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Country | US
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Telephone | 267-990-3019
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Fax |
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Provider Business Mailing Address
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Address Line | 109 BOHEMIAN DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-9281
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOYCE BOAFO
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Credential |
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Telephone | 833-711-4299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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