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General NPI Number Information
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NPI Number | 1629270699
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOSPICE CARE, INC.
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 17215 STUDEBAKER RD SUITE 100
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City | CERRITOS
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State | CA
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Zip | 90703-2548
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Country | US
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Telephone | 562-865-9006
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Fax | 562-865-9022
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Provider Business Mailing Address
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Address Line | 17215 STUDEBAKER RD SUITE 100
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City | CERRITOS
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State | CA
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Zip | 90703-2548
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Country | US
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Telephone | 562-865-9006
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Fax | 562-865-9022
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LYDIA Y AHN
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Credential | RN, PHN
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Telephone | 562-865-9006
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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 | 550000319
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License Number State | CA
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