Organization
EVERGREEN HEALTH CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL P KELLY (PRESIDENT)
(570) 969-2188
Entity
Organization
Contact information
Practice address
701 CLAY AVE, SCRANTON, PA 18510-1759
(570) 344-2800
(570) 344-1977
Mailing address
401 MOLTKE AVE, SCRANTON, PA 18505-2886
(570) 969-2188
(570) 969-2189
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
133802
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1024773960001
—
PA
Enumeration date
06/23/2010
Last updated
09/07/2010
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