| Organization Name: | EVERGREEN CARE CENTER LTD |
| NPI Number: | 1447449616 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS JOSEPH (OWNER) |
| Mailing Address: | 9760 S Kedzie Ave Suite 3 Evergreen Park |
| State: | IL US |
| Postal Code: | 608053109 |
| Phone Number: | 7084236209 |
| Fax Number: | 7084239021 |
| NPI Enumeration Date: | 10/23/2007 |
| NPI Last Update Date: | 07/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |