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General NPI Number Information
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NPI Number | 1386997070
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Entity Type | Organization
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Legal Business Name | EVERGREEN BAY FAMILY CARE, INC.
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 10/18/2012
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Provider Practice Location Address
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Address Line | 1900 S NORFOLK ST STE 350
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City | SAN MATEO
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State | CA
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Zip | 94403-1171
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Country | US
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Telephone | 650-532-3122
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Fax | 650-240-3860
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Provider Business Mailing Address
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Address Line | 1900 S NORFOLK ST STE 350
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City | SAN MATEO
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State | CA
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Zip | 94403-1171
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Country | US
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Telephone | 650-532-3122
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Fax | 650-240-3860
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. PEGGY MILNE
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Credential |
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Telephone | 650-532-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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