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General NPI Number Information
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NPI Number | 1104821537
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOME HEALTH, INC.
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 10/08/2007
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Provider Practice Location Address
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Address Line | 17215 STUDEBAKER RD STE 270
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City | CERRITOS
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State | CA
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Zip | 90703-2522
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Country | US
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Telephone | 562-860-9444
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Fax | 562-860-8334
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Provider Business Mailing Address
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Address Line | 17215 STUDEBAKER RD STE 270
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City | CERRITOS
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State | CA
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Zip | 90703-2522
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Country | US
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Telephone | 562-860-9444
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Fax | 562-860-8334
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MRS. LYDIA Y AHN
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Credential | RN, PHN
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Telephone | 562-860-9444
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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 | CA
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