Evergreen Home Care & Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

EVERGREEN HOME CARE & HOSPICE INC

Practice address

3756 Santa Rosalia Dr Ste 520B
Los Angeles, CA 90008-3656

Phone

(323) 293-7072

Fax

(323) 293-7123

NPI assigned

Dec 5, 2013

Last updated

Dec 5, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sharon Selico

Title

Administrator

Phone

(323) 293-7072

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659702389. Details of each certification follow.

• CCN A01681 Hospice · Active · Details

Hospice certification: CCN A01681

Legal name

EVERGREEN HOME CARE & HOSPICE INC

Doing business as

FOREVER CARING HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 13, 2019

Last certification

Sep 13, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Aug 18, 2009 in CA

Enrollment address

3756 Santa Rosalia Dr
Ste 520B
Los Angeles, CA 90008-3606

Listed as

A C Hospice, IncCCN 551579

Ownership

For-Profit

Certified

Oct 16, 2009

Medicare certification status

ActiveFrom the Provider of Services file

Listed as

Evergreen Home Care & Hospice, IncCCN A01681 · All quality measures

Ownership

For-Profit

Certified

Sep 13, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 4

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Babak Roozrokh, M.D.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Los Angeles, CA
  • NPI 1326078361

  Contracted Managing Employee

  CMS ownership

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

{
    "created_epoch": "1386201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386201600000",
    "number": "1659702389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3756 SANTA ROSALIA DR STE 520B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900083656",
            "telephone_number": "323-293-7072",
            "fax_number": "323-293-7123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3756 SANTA ROSALIA DR STE 520B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900083656",
            "telephone_number": "323-293-7072",
            "fax_number": "323-293-7123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HOME CARE & HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-05",
        "last_updated": "2013-12-05",
        "status": "A",
        "authorized_official_last_name": "SELICO",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "323-293-7072"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Everett
• Jihan A Everett, M.S. CCC-SLP
• John M Everett, CRNA
• Marcia Lynn Everett, R.D.
• Evergreen Fund (Red Door Life)
• Evergreen International Group, LLC
• Evergreen Psychology New York P.C.
• Evergreen RX Inc (Medico Pharmacy)
• Evergreen Wellness Center Inc.
• Matthew William Everhart, LCSW, MSW

• Community Based Hospice Care Agency in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; 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.