Provider Demographics
NPI:1053038943
Name:EVERGREEN HOME CARE LLC
Entity type:Organization
Organization Name:EVERGREEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KULDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, BSN, RN
Authorized Official - Phone:864-340-0442
Mailing Address - Street 1:255 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3033
Mailing Address - Country:US
Mailing Address - Phone:864-340-0442
Mailing Address - Fax:
Practice Address - Street 1:7 PROGRESS ST STE 101A
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1102
Practice Address - Country:US
Practice Address - Phone:864-340-0442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health