# EVERGREEN HEALTH CARE CENTER, LLC

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

## Provider details

- **NPI number:** 1811208077
- **Authorized official:** MR. MICHAEL P KELLY (PRESIDENT)
- **Authorized official phone:** (570) 969-2188

## Contact information

- **Practice address:** 701 CLAY AVE, SCRANTON, PA 18510-1759
- **Practice address phone:** (570) 344-2800
- **Practice address fax:** (570) 344-1977
- **Mailing address:** 401 MOLTKE AVE, SCRANTON, PA 18505-2886
- **Mailing address phone:** (570) 969-2188
- **Mailing address fax:** (570) 969-2189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 133802 | PA | Yes |

## Other

- **Enumeration date:** 06/23/2010
- **Last updated:** 09/07/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1024773960001 | — | PA |