Evergreen Living Home Inc.
Organization Active NPI Adult Care Home Facility · Leicester, NC
NPI 1861512972 · NPPES record last updated Sep 8, 2023
Key facts
- NPI
- 1861512972
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Care Home Facility 311ZA0620X
- License
- FCL-011-195 (NC)
- Legal business name
- EVERGREEN LIVING HOME INC.
- Practice address
- 103 Country Time LN
Leicester, NC 28748 - Phone
- (828) 779-5588
- NPI assigned
- Mar 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Young Song Lee
- Title
- Owner
- Phone
- (828) 779-5588
Corporate family (same tax ID) 18
National Provider Directory
- Tax ID family
- Evergreen Living 4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | FCL-011-195 | NC | Yes |
Addresses
Primary practice location
103 Country Time LN
Leicester, NC 28748
Mailing address
PO Box 2077
Leicester, NC 28748-2077
Phone (828) 779-5588
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7805222 | Medicaid | NC |
Other names
- EVERGREEN LIVING HOME #3
Other providers in Leicester, NC
- Evergreen Living Home Inc.
- Evergreen Living Home Inc.
- Evergreen Living Home Inc.
- Evergreen Living Home Inc.
- Evergreen Living Home Inc.
- Evergreen Living Homes #5
- Evergreen Living Homes #8
- Patrick Flannelly
- Robert Michael Gaddy Jr.
- Linda L Gardner
All providers in Leicester, NC · Adult Care Home Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.