- Enrollment id
- O20030807000024
- Enrollment state
- CA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1104821537
- Multiple npi flag
- N
- Ccn
- 058132
- Associate id
- 6800707472
- Organization name
- EVERGREEN HOME HEALTH, INC.
- Incorporation date
- 2002-02-20
- Incorporation state
- CA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 17215 STUDEBAKER RD
- Address line 2
- STE 270
- City
- CERRITOS
- State
- CA
- Zip code
- 907032522