| NPI | 1811010143 |
|---|---|
| Doing Business As | EVERGREEN LIVING HOME #12 |
| Entity Type | Organization |
| Authorized Contact | YOUNG SONG LEE Owner 828-779-5588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2023-09-08 |