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General NPI Number Information
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NPI Number | 1518301902
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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 | 04/29/2013
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 5280 S COMMERCE DR E160
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City | MURRAY
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State | UT
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Zip | 84107-7926
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Country | US
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Telephone | 801-364-4250
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Fax | 801-994-1278
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Provider Business Mailing Address
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Address Line | 5280 S COMMERCE DRIVE E160 E160
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City | MURRAY
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State | UT
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Zip | 84107-7926
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Country | US
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Telephone | 801-364-4250
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Fax | 801-994-1278
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. STEPHANIE BEAR
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Credential |
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Telephone | 435-753-2438
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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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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2013-HOSPICE-UT00058
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License Number State | UT
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