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General NPI Number Information
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NPI Number | 1205503117
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOME CARE
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 2852 BOUDINOT AVE STE 202
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City | CINCINNATI
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State | OH
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Zip | 45238-2461
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Country | US
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Telephone | 614-592-8678
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Fax |
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Provider Business Mailing Address
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Address Line | 2852 BOUDINOT AVE
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City | CINCINNATI
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State | OH
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Zip | 45238-2461
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Country | US
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Telephone | 614-592-8678
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | OMAR Y FARAH
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Credential | MANAGER
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Telephone | 614-592-8678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State |
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