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General NPI Number Information
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NPI Number | 1700700507
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Entity Type | Organization
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Legal Business Name | EVERGREEN GOLDEN AGE
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 221 BELMONT TER
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City | MOUNT VERNON
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State | WA
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Zip | 98274-4519
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Country | US
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Telephone | 425-900-2848
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Fax |
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Provider Business Mailing Address
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Address Line | 13525 22ND AVE SE
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City | MILL CREEK
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State | WA
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Zip | 98012-5691
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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 | PROVIDER/OWNER
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Name | BRANDON LIU
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Credential |
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Telephone | 425-900-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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