NPIMap

Organization Active NPI

Evergreen Home Health, Inc.

  • Home Health Agency
  • Cerritos, CA
National Provider Identifier
1104821537
Registry record updated Oct 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
EVERGREEN HOME HEALTH, INC.
Practice address
17215 Studebaker Rd
Ste 270
Cerritos, CA 90703-2522
Phone
(562) 860-9444
Fax
(562) 860-8334
NPI assigned
Jun 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Lydia Y Ahn, RN, PHN
Title
Administrator/Ceo
Phone
(562) 860-9444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X CA Primary

Addresses

Primary practice location

17215 Studebaker Rd
Ste 270
Cerritos, CA 90703-2522

Mailing address

17215 Studebaker Rd
Ste 270
Cerritos, CA 90703-2522
Phone (562) 860-9444

Other identifiers 1

IdentifierTypeStateIssuer
HHA08132FMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030807000024 CA Part A Provider - Home Health Agency 6800707472 Practice locations: Cerritos, CA

Home health agency certification: CCN 058132

Legal name
EVERGREEN HOME HEALTH, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 13, 2002
Last certification
May 21, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Feb 20, 2002 in CA
Enrollment address
17215 Studebaker Rd
Ste 270
Cerritos, CA 90703-2522

Care Compare: Home health agency

Medicare Care Compare
Listed as
Evergreen Home HealthCCN 058132
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Sep 13, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0999277Evergreen Home Health Inc17215 Studebaker Rd Ste 270, Cerritos, CA 90703Certificate of waiverMay 7, 2028

National Provider Directory

National Provider Directory

Locations

17215 Studebaker Rd
Ste 270
Cerritos, CA 90703
Phone (562) 860-9444

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lydia Y Ahn Individual 5% Or Greater Direct Ownership Interest Feb 20, 2002 100%
Corporate OfficerCeo, Secretary, Board Member Feb 20, 2002 98%
Corporate DirectorCeo, Secretary, Board Member Feb 20, 2002 98%
W-2 Managing EmployeeCeo, Secretary, Board Member, Ad Feb 20, 2002 96%
Operational/Managerial ControlCeo, Secretary, Board Member, Ad Feb 20, 2002 98%
Gina M Daly Individual W-2 Managing EmployeeDirector of Patienct Care Servic Feb 6, 2017 2%
John J Ahn Individual Corporate OfficerCfo, Board Member Apr 15, 2002 2%
Corporate DirectorCfo, Board Member Apr 15, 2002 2%
W-2 Managing EmployeeCfo, Board Member, Asst Administ Nov 28, 2007 2%
Operational/Managerial ControlCfo, Board Member, Asst Administ Apr 15, 2002 2%

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191801600000",
    "number": "1104821537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17215 STUDEBAKER RD",
            "address_2": "STE 270",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032522",
            "telephone_number": "562-860-9444",
            "fax_number": "562-860-8334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17215 STUDEBAKER RD",
            "address_2": "STE 270",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032522",
            "telephone_number": "562-860-9444",
            "fax_number": "562-860-8334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HOME HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-13",
        "last_updated": "2007-10-08",
        "status": "A",
        "authorized_official_last_name": "AHN",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "562-860-9444",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, PHN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HHA08132F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cerritos, CA

Sources for this page

Verify at the official NPI Registry.