# EVERGREEN HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** EVERGREEN HOME HEALTHCARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467314070
- **Authorized official:** ELSIE ADONTENG-BOATENG (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (571) 295-3879

## Contact information

- **Practice address:** 3115 GOLANSKY BLVD, WOODBRIDGE, VA 22192-4223
- **Practice address phone:** (571) 295-3879
- **Mailing address:** 3115 GOLANSKY BLVD, WOODBRIDGE, VA 22192-4223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 12/02/2025
- **Last updated:** 12/02/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | HCO-0005732 | HCO | VA |