Provider Demographics
NPI:1447061924
Name:EVERGREEN HOME HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:EVERGREEN HOME HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTED LIVING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAMA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SAIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-469-7560
Mailing Address - Street 1:16386 ELLERDALE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1411
Mailing Address - Country:US
Mailing Address - Phone:320-469-7560
Mailing Address - Fax:
Practice Address - Street 1:2621 S HEIGHTS DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3512
Practice Address - Country:US
Practice Address - Phone:320-469-7560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility