Organization
EVERGREEN ELDER CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES R CRAWFORD PHD (OWNER/DIRECTOR)
(210) 826-2116
Entity
Organization
Contact information
Practice address
7340 BLANCO RD, SUITE 1122, SAN ANTONIO, TX 78216-4966
(210) 826-2116
(210) 525-8979
Mailing address
7340 BLANCO RD, SUITE 1122, SAN ANTONIO, TX 78216-4966
(210) 826-2116
(210) 525-8979
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1728479-01
—
TX
01
—
31420501578216-8001
TRICARE GROUP NUMBER
TX
Enumeration date
10/04/2006
Last updated
07/08/2011
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