Evergreen Living #4
Custodial Care Facility, Adult Care Home in Leicester, NC. Organization (NPI-2).
NPI number1255452017
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1255452017
- Entity type
- Organization (NPI-2)
- Legal business name
- Evergreen Living #4
- Organization subpart
- No
- Enumeration date
- Apr 2, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 311ZA0620X | Custodial Care Facility, Adult Care Home | FCL-011-196 | NC | Yes |
Practice location
351 Family Ridge RoadLeicester, NC 28748
Phone 828-779-5588
Mailing address
Po Box 2077Leicester, NC 28748-2077
Phone 828-779-5588
Authorized official
Young S Lee
Owner
8287795588
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