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Organization
EVERGREEN HEALTHCARE LLC
Active
Organization
EVERGREEN HEALTHCARE LLC
Active
Other names
EVERGREEN HOME HEALTHCARE
Organization subpart
No
Provider details
NPI number
Authorized official
ELSIE ADONTENG-BOATENG (DIRECTOR OF OPERATIONS)
(571) 295-3879
Entity
Organization
Contact information
Practice address
3115 GOLANSKY BLVD, WOODBRIDGE, VA 22192-4223
(571) 295-3879
Mailing address
3115 GOLANSKY BLVD, WOODBRIDGE, VA 22192-4223
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
385H00000X
Respite Care
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCO-0005732
HCO
VA
Enumeration date
12/02/2025
Last updated
12/02/2025
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