MEDICARE: EVERGREEN HOME HEALTH CARE AGENCY 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
1	251E00000X	Home Health Agency	HP0187200	NJ

General Provider Information

NPI Number	:	1710391990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN HOME HEALTH CARE AGENCY INC.

Provider Business Mailing Address
First Line	:	13 LAKE VIEW BLVD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-5419
Country	:	US
Telephone Number	:	848-459-8301
Fax Number	:	888-664-5617

Provider Business Practice Location Address
First Line	:	13 LAKE VIEW BLVD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-5419
Country	:	US
Telephone Number	:	848-459-8301
Fax Number	:	888-664-5617

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MS. ROSALINE SHAU
Credential	:
Telephone Number	:	848-459-8301

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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