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General NPI Number Information
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NPI Number | 1902615966
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Entity Type | Organization
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Legal Business Name | EVERGREEN PATHWAYS HOME LLC
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 3500 GROVE CITY RD
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City | GROVE CITY
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State | OH
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Zip | 43123-2598
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Country | US
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Telephone | 614-230-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 GROVE CITY RD
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City | GROVE CITY
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State | OH
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Zip | 43123-2598
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Country | US
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Telephone | 614-230-7005
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAILA MOHAMED
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Credential |
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Telephone | 614-230-7005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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