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General NPI Number Information
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NPI Number | 1245881556
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Entity Type | Organization
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Legal Business Name | EVERGREEN ADULT CARE LLC
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Dates
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Enumeration Date | 09/27/2019
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 270 HIGHLAND RD
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1514
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Country | US
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Telephone | 732-207-5893
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Fax |
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Provider Business Mailing Address
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Address Line | 270 HIGHLAND RD
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1514
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Country | US
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Telephone | 732-207-5893
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Fax | 732-777-1449
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Authorized Official
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Title or Position | MANAGER ADMIN
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Name | WAHID SHIBLI
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Credential |
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Telephone | 732-207-5893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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