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General NPI Number Information
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NPI Number | 1891250999
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOME HEALTHCARE IHSS, LLC.
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 1235 W 124TH AVE STE 102
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City | WESTMINSTER
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State | CO
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Zip | 80234-1725
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Country | US
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Telephone | 970-310-7457
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 W 124TH AVE STE 102
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City | WESTMINSTER
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State | CO
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Zip | 80234-1725
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Country | US
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Telephone | 970-310-7457
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AARON ELLSWORTH
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Credential |
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Telephone | 970-310-7457
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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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