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General NPI Number Information
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NPI Number | 1598367849
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Entity Type | Organization
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Legal Business Name | EVERGREEN ADULT DAY CARE
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 1500 KAPIOLANI BLVD STE 102E
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City | HONOLULU
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State | HI
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Zip | 96814-3732
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Country | US
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Telephone | 808-372-8257
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Fax | 808-946-7571
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Provider Business Mailing Address
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Address Line | 1500 KAPIOLANI BLVD STE 102E
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City | HONOLULU
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State | HI
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Zip | 96814-3732
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Country | US
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Telephone | 808-372-8257
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Fax | 808-946-7571
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL J PARK
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Credential |
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Telephone | 808-946-7505
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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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