MEDICARE: EVERGREEN HOME CARE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1932936234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN HOME CARE

Provider Business Mailing Address
First Line	:	2346 S LYNHURST DR STE D101
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-5169
Country	:	US
Telephone Number	:	310-357-9042
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 S LYNHURST DR STE D101
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-5169
Country	:	US
Telephone Number	:	310-357-9042
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HAMMAD HAMMAD
Credential	:
Telephone Number	:	310-357-9042

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	09/19/2024

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Directions to “EVERGREEN HOME CARE ” Practice Location

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