# EVERGREEN HOME HEALTH CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174526453
- **Authorized official:** MR. RICHARD KELTERBORN (ADMINISTRATOR)
- **Authorized official phone:** (248) 620-1211

## Contact information

- **Practice address:** 5980 S MAIN ST, SUITE 102, CLARKSTON, MI 48346
- **Practice address phone:** (248) 620-1211
- **Practice address fax:** (248) 620-1214
- **Mailing address:** 5980 S MAIN ST, SUITE 102, CLARKSTON, MI 48346
- **Mailing address phone:** (248) 620-1211
- **Mailing address fax:** (248) 620-1214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | MI638061 | MI | Yes |

## Other

- **Enumeration date:** 05/31/2005
- **Last updated:** 08/22/2020