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General NPI Number Information
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NPI Number | 1487335709
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Entity Type | Organization
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Legal Business Name | EVERGREEN LIFE CARE HOMES INC.
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 542 W BROWNING AVE
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City | FRESNO
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State | CA
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Zip | 93704-1802
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Country | US
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Telephone | 498-483-0196
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Fax | 449-468-0030
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Provider Business Mailing Address
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Address Line | 3092 HANSON AVE
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City | CLOVIS
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State | CA
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Zip | 93611-3917
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Country | US
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Telephone | 408-483-0196
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Fax | 559-468-0030
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Authorized Official
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Title or Position | LICENSEE/ADMINISTRATOR
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Name | MINAKSHI ROYCHOUDHURY
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Credential |
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Telephone | 408-483-0196
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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 |
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License Number State |
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