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General NPI Number Information
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NPI Number | 1295284453
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Entity Type | Organization
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Legal Business Name | EVERGREEN COURT HOME FOR ADULTS SP LLC
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 65 LAFAYETTE ST
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City | SPRING VALLEY
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State | NY
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Zip | 10977-5184
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Country | US
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Telephone | 845-356-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 29 WHISPERING PINES LN
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1421
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JOSEPH SCHONBERGER
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Credential |
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Telephone | 732-363-7770
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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 | 620-F-078
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License Number State | NY
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