Organization
EVERGREEN LIVING HOME INC.
Active
Other names
EVERGREEN LIVING HOME #3
Organization subpart
No
Provider details
NPI number
Authorized official
YOUNG SONG LEE (OWNER)
(828) 779-5588
Entity
Organization
Contact information
Practice address
103 COUNTRY TIME LN, 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-011-195
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805222
—
NC
Enumeration date
03/30/2007
Last updated
09/08/2023
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