# EVERGREEN LIVING HOME INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EVERGREEN LIVING HOME \#10
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295856052
- **Authorized official:** YOUNG SONG LEE (OWNER)
- **Authorized official phone:** (828) 779-5588

## Contact information

- **Practice address:** 236 COUNTRY TIME CIRCLE, LEICESTER, NC 28748
- **Practice address phone:** (828) 779-5588
- **Mailing address:** PO BOX 2077, LEICESTER, NC 28748-2077
- **Mailing address phone:** (828) 779-5588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL-011-223 | NC | Yes |

## Other

- **Enumeration date:** 04/02/2007
- **Last updated:** 09/08/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805449 | — | NC |