Evergreen Home Care LTD

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1010796 Issued in IL

Legal business name

EVERGREEN HOME CARE LTD

Practice address

6041 Dempster St
Morton Grove, IL 60053

Phone

(847) 470-9280

Fax

(847) 470-9282

NPI assigned

Aug 20, 2006

Reactivated

Dec 8, 2018

Last updated

Sep 30, 2020By 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

Gloria S Kim, RN

Title

President

Phone

(847) 470-9280

Specialties & licenses 2

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gloria S. Park, RN

  • Registered Nurse
  • Chicago, IL
  • NPI 1992755862
  NPD
• Michael Antonio Dela Cruz Salacup, RPT

  • Physical Therapist
  • Morton Grove, IL
  • NPI 1174953053
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1750496667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6041 DEMPSTER ST",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532943",
            "telephone_number": "847-470-9280",
            "fax_number": "847-470-9928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6041 DEMPSTER ST",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "60053",
            "telephone_number": "847-470-9280",
            "fax_number": "847-470-9282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HOME CARE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "deactivation_date": "2018-11-30",
        "reactivation_date": "2018-12-08",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-470-9280",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1010796",
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adriana Daniela Ene
• Bom Mi Eom
• Ermin Arriola MD LLC
• Esther Insun Kim, DDS, LTD
• Tonya Evans, SLP
• Ez Healthcare PLLC
• Delia Famanas, RN
• Samiebert Famanas, RN
• Faminamed Healthcare Providers SC
• Farheen Farooq

• Home Health Agency in Morton Grove, IL
• Providers in Morton Grove, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.