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General NPI Number Information
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NPI Number | 1669937942
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Entity Type | Organization
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Legal Business Name | EVERGREEN PRIVATE CARE OF FLORIDA LLC
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 7301 SW GAINES AVE
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City | STUART
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State | FL
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Zip | 34997-7332
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Country | US
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Telephone | 281-320-1856
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1187
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City | HOBE SOUND
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State | FL
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Zip | 33475-1187
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEREN WHEELER
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Credential |
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Telephone | 772-888-6962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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