Organization
EVERGREEN LIVING #4
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YOUNG S LEE (OWNER)
(828) 779-5588
Entity
Organization
Contact information
Practice address
351 FAMILY RIDGE ROAD, LEICESTER, NC 28748
(828) 779-5588
Mailing address
PO BOX 2077, LEICESTER, NC 28748-2077
(828) 779-5588
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-011-196
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805221
—
NC
Enumeration date
04/02/2007
Last updated
08/22/2020
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