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General NPI Number Information
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NPI Number | 1629584081
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Entity Type | Organization
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Legal Business Name | EVERGREEN CAREGIVERS, INC.
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 846 W PALMDALE BLVD
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City | PALMDALE
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State | CA
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Zip | 93551-4250
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Country | US
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Telephone | 661-310-1989
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Fax | 661-888-5821
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Provider Business Mailing Address
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Address Line | 38713 TIERRA SUBIDA AVE STE 200-126
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City | PALMDALE
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State | CA
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Zip | 93551-4562
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Country | US
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Telephone | 661-310-1989
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Fax | 661-888-5821
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Authorized Official
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Title or Position | CEO
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Name | MR. PAUL LYNN WILSON
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Credential | CHAA
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Telephone | 661-310-1989
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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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