Evergreen Home Care

Primary specialty

Home Health Clinical Nurse SpecialistTaxonomy code 364SH0200X

Legal business name

EVERGREEN HOME CARE

Practice address

2852 Boudinot Ave Ste 202
Cincinnati, OH 45238-2461

Phone

(614) 592-8678

NPI assigned

Aug 27, 2021

Organization subpart

No

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

Authorized official

Name

Omar Y Farah, MANAGER

Title

Ceo

Phone

(614) 592-8678

Specialties & licenses 1

Addresses

Other names 2

• Evergreen Home care Doing business as
• evergreen home carr Doing business as

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Home health agency certification: CCN 369361

Legal name

EVERGREEN HOME CARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jul 20, 2023

Last certification

Jul 7, 2023

Organization structure

CorporationProprietary

Incorporated

Aug 17, 2021 in OH

Enrollment address

2852 Boudinot Ave
Ste 202
Cincinnati, OH 45238-2461

Listed as

Evergreen Home CareCCN 369361

Ownership

-

Certified

Jul 20, 2023

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

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

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714694400000",
    "number": "1205503117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2852 BOUDINOT AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452382461",
            "telephone_number": "614-592-8678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2852 BOUDINOT AVE STE 202",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452382461",
            "telephone_number": "614-592-8678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HOME CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-27",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A",
        "authorized_official_last_name": "FARAH",
        "authorized_official_first_name": "OMAR",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "614-592-8678",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "364SH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Axxess",
            "affiliation": "N",
            "endpointDescription": "Evergeen Home care",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Axxess",
            "address_1": "2852 Boudinot Ave",
            "city": "Cincinnati",
            "state": "OH",
            "country_code": "US",
            "postal_code": "452382461",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "axxess",
            "affiliation": "N",
            "endpointDescription": "Evergeen Home care",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Axxess",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Evergeen Home care",
            "address_1": "2852 Boudinot Ave",
            "city": "Cincinnati",
            "state": "OH",
            "country_code": "US",
            "postal_code": "452382461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Evergreen Home care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "evergreen home carr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Everest Healthcare Ohio, Inc.
• Dayton F Everett
• Jessica N Everett, M.S.
• Patrice L Everett
• Ricahrd Everett, RN
• Evergreen Southwest Behavioral Health Services LLC
• Tyler Jay Everhardt, PHARMD
• Joseph Lynn Everhart, DC
• Michael R. Everhart, CRNA
• Scott L Everhart, PA-C

• Clinical Nurse Specialist in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Clinical Nurse Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.