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General NPI Number Information
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NPI Number | 1932582715
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Entity Type | Organization
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Legal Business Name | EVERGREEN ADULT MEDICAL DAY CARE
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 9290 GAITHER RD
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1420
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Country | US
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Telephone | 301-527-1100
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Fax | 301-658-3240
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Provider Business Mailing Address
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Address Line | 9290 GAITHER RD
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City | GAITHERSBURG
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State | MD
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Zip | 20877-1420
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Country | US
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Telephone | 301-527-1100
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Fax | 301-658-3240
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JADEN JOON KIM
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Credential |
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Telephone | 301-527-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 15011A
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License Number State | MD
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