Organization
EVERGREEN SUPPORTED LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTA MOORE DBA, MSN, CNP (CEO)
(614) 205-9982
Entity
Organization
Contact information
Practice address
5150 E MAIN ST STE 102, WHITEHALL, OH 43213-2441
(614) 205-9982
Mailing address
5150 E MAIN ST STE 102, WHITEHALL, OH 43213-2441
(614) 205-9982
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
06/25/2016
Last updated
06/25/2016
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