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NPI Code Detail

MEDICARE: EVERGREEN BAY FAMILY CARE, INC.

MEDICARE: EVERGREEN BAY FAMILY CARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1386997070
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVERGREEN BAY FAMILY CARE, INC.
Provider Business Mailing Address
First Line : 1900 S NORFOLK ST STE 350
Second Line :
City : SAN MATEO
State : CA
Zip : 94403-1171
Country : US
Telephone Number : 650-532-3122
Fax Number : 650-240-3860
Provider Business Practice Location Address
First Line : 1900 S NORFOLK ST STE 350
Second Line :
City : SAN MATEO
State : CA
Zip : 94403-1171
Country : US
Telephone Number : 650-532-3122
Fax Number : 650-240-3860
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : MS. PEGGY MILNE
Credential :
Telephone Number : 650-532-3122
Provider Enumeration Date : 10/18/2012
Last Update Date : 10/18/2012

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Directions to “EVERGREEN BAY FAMILY CARE, INC. ” Practice Location

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