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General NPI Number Information
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NPI Number | 1215936539
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Entity Type | Organization
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Legal Business Name | EVERGREEN HEALTHCARE SERVICES, INC.
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 417 MALLEABLE ST
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City | SHARON
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State | PA
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Zip | 16146-1936
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Country | US
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Telephone | 724-347-7344
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Fax | 724-347-7345
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Provider Business Mailing Address
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Address Line | 417 MALLEABLE ST
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City | SHARON
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State | PA
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Zip | 16146-1936
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Country | US
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Telephone | 724-347-7344
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Fax | 724-347-7345
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DEBORAH NICOLE BAILEY
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Credential | BS
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Telephone | 724-854-1839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 78111
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License Number State | OH
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