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General NPI Number Information
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NPI Number | 1356742340
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOSPICE LLC
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 24333 ORCHARD LAKE RD STE H
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1976
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Country | US
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Telephone | 248-817-5859
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Fax | 248-817-5876
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Provider Business Mailing Address
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Address Line | 24333 ORCHARD LAKE RD STE H
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1976
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Country | US
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Telephone | 248-817-5859
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Fax | 248-817-5876
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GEOFFREY JIMENEZ
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Credential |
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Telephone | 248-817-5859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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