NPIMap

Organization Active NPI

Evergreen Healthcare Services, Inc.

  • Non-emergency Medical Transport (VAN)
  • Niles, OH
National Provider Identifier
1457565780
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-emergency Medical Transport (VAN)Taxonomy code 343900000X
License
2437643 Issued in OH
Legal business name
EVERGREEN HEALTHCARE SERVICES, INC.
Practice address
609 Vienna Ave
Niles, OH 44446
Phone
(330) 652-3355
Fax
(330) 652-1477
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Authorized official

Name
Ms. Deborah N Bailey, MED
Title
President
Phone
(330) 652-3355

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 2437643 OH
Community Based Hospice Care Agency 251G00000X 2437643 OH
Community Based Hospice Care Agency 251G00000X 0019704300003 PA
Non-emergency Medical Transport (VAN) 343900000X 2437643 OH Primary

Addresses

Primary practice location

609 Vienna Ave
Niles, OH 44446

Mailing address

Evergreen Healthcare Services, Inc.
PO Box 221
Niles, OH 44446
Phone (330) 652-3355

Other identifiers 2

IdentifierTypeStateIssuer
0019704300003MedicaidPA
2434376MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Healthcare Services Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

51 E Park Ave
Ste 1
Niles, OH 44446

609 Vienna Ave
Niles, OH 44446
Phone (330) 652-3355

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1457565780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "EVERGREEN HEALTHCARE SERVICES, INC.",
            "address_2": "PO BOX 221",
            "city": "NILES",
            "state": "OH",
            "postal_code": "44446",
            "telephone_number": "330-652-3355",
            "fax_number": "330-652-1477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 VIENNA AVE",
            "city": "NILES",
            "state": "OH",
            "postal_code": "44446",
            "telephone_number": "330-652-3355",
            "fax_number": "330-652-1477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HEALTHCARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-652-3355",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "OH",
            "license": "2437643",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OH",
            "license": "2437643",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "PA",
            "license": "0019704300003",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "OH",
            "license": "2437643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019704300003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2434376",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.