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General NPI Number Information
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NPI Number | 1215752993
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Entity Type | Organization
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Legal Business Name | EVERGREEN SENIOR HOME CARE AT CORONA LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 826 PASEO GRANDE
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City | CORONA
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State | CA
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Zip | 92882-2841
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Country | US
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Telephone | 951-893-0859
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27009
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City | ANAHEIM
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State | CA
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Zip | 92809-0100
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Country | US
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Telephone | 951-893-0859
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TAMANNA RAHMAN
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Credential |
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Telephone | 951-893-0859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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