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General NPI Number Information
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NPI Number | 1467254235
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Entity Type | Organization
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Legal Business Name | EVERGREEN HEALTH CARE & GROUP HOME LLC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 7147 MOUNT ZION CIR APT 1203
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City | MORROW
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State | GA
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Zip | 30260-3330
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Country | US
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Telephone | 943-238-3539
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Fax |
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Provider Business Mailing Address
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Address Line | 7147 MOUNT ZION CIR APT 1203
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City | MORROW
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State | GA
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Zip | 30260-3330
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Country | US
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Telephone | 470-894-0009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DELVINE NKONGHO AYUK
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Credential | DELVINE AYUK
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Telephone | 943-238-3539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #8
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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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