NPIMap

Organization Active NPI

Evergreen Health Care Management LLC

  • Home Health Agency
  • Annandale, VA
National Provider Identifier
1235647348
Registry record updated Jun 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HCO-1805 Issued in VA
Legal business name
EVERGREEN HEALTH CARE MANAGEMENT LLC
Practice address
4115 Annandale Road, Suite 208
Annandale, VA 22003-2200
Phone
(703) 534-5049
Fax
(888) 588-3957
NPI assigned
Jan 11, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2026

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

Authorized official

Name
Jin Choi, RN
Title
Owner
Phone
(571) 505-1119

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered NurseGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 163WH0200X
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Home Health Agency 251E00000X HCO-1805 VA Primary
Community Based Hospice Care Agency 251G00000X
Primary Care Clinic/Center 261QP2300X
Durable Medical Equipment & Medical Supplies 332B00000X
Transportation Network Company 342000000X
Non-emergency Medical Transport (VAN) 343900000X
Taxi 344600000X
Bus 347B00000X
Private Vehicle 347C00000X
Transportation Broker 347E00000X

Addresses

Primary practice location

4115 Annandale Road, Suite 208
Annandale, VA 22003-2200

Mailing address

8868 Winding Hollow Way
Springfield, VA 22152-1449

Other practice location 1

8868 Winding Hollow Way
Springfield, VA 22152
Phone (571) 505-1119

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180508001151 VA Part A Provider - Home Health Agency 5799049300 Practice locations: Fairfax, VA
O20191004001578 VA Part A Provider - Hospice 5799049300 Practice locations: Annandale, VA

Home health agency certification: CCN 497761

Legal name
EVERGREEN HEALTH CARE MANAGEMENT, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 9, 2019
Last certification
Jan 9, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jul 12, 2017 in VA
Enrollment address
8704 Lee Hwy
Fairfax, VA 22031

Hospice certification: CCN 491642

Legal name
EVERGREEN HEALTH CARE MANAGEMENT, LLC
Doing business as
EVERGREEN HEALTH CARE MANAGEMENT
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 11, 2021
Last certification
Jun 11, 2021
Ownership / control type
Proprietary - Individual
Organization structure
LLCProprietary
Incorporated
Jul 12, 2017 in VA
Enrollment address
4115 Annandale Rd
Ste 208
Annandale, VA 22003-2500

Care Compare: Home health agency

Medicare Care Compare
Listed as
Evergreen Health Care Management LLCCCN 497761
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
Jan 9, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Physical therapy, Occupational therapy

Care Compare: Hospice

Medicare Care Compare
Listed as
Evergreen Health Care ManagementCCN 491642
Ownership
For-Profit
Certified
Jun 11, 2021
Medicare certification status
ActiveFrom the Provider of Services file

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
49D2158220Evergreen Health Care Management4115 Annandale Road Suite 208, Annandale, VA 22003Certificate of waiverNov 25, 2026

National Provider Directory

National Provider Directory

Locations

4115 Annandale Rd
Ste 208
Annandale, VA 22003
Phone (703) 534-5049

Ownership & related parties

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.

NameRoleSinceShare
Jin Mi Choi Individual 5% Or Greater Direct Ownership InterestOwner Jul 12, 2017 100%
Corporate OfficerAdministrator Jul 12, 2018
Corporate DirectorAdministrator Jul 12, 2018
Operational/Managerial ControlAdministrator Jul 12, 2018
5% Or Greater Direct Ownership Interest Jul 12, 2017 100%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 2

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": "1515628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782345600000",
    "number": "1235647348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8868 WINDING HOLLOW WAY",
            "city": "SPRINGFIELD",
            "state": "VA",
            "postal_code": "221521449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 ANNANDALE ROAD, SUITE 208",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032200",
            "telephone_number": "703-534-5049",
            "fax_number": "888-588-3957"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8868 Winding Hollow Way",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "VA",
            "postal_code": "22152",
            "country_code": "US",
            "telephone_number": "571-505-1119",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN HEALTH CARE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-11",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A",
        "authorized_official_last_name": "CHOI",
        "authorized_official_first_name": "JIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "571-505-1119",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "VA",
            "license": "HCO-1805",
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "342000000X",
            "taxonomy_group": "",
            "desc": "Transportation Network Company",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "344600000X",
            "taxonomy_group": "",
            "desc": "Taxi",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347B00000X",
            "taxonomy_group": "",
            "desc": "Bus",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "347E00000X",
            "taxonomy_group": "",
            "desc": "Transportation Broker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annandale, VA

Sources for this page

Verify at the official NPI Registry.