Provider Demographics
NPI:1053986273
Name:GREENWOOD HCI SOTERIA, LLC
Entity type:Organization
Organization Name:GREENWOOD HCI SOTERIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-603-7235
Mailing Address - Street 1:8089 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1847
Mailing Address - Country:US
Mailing Address - Phone:810-603-7235
Mailing Address - Fax:
Practice Address - Street 1:8089 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1847
Practice Address - Country:US
Practice Address - Phone:810-603-7235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health