EVERGREEN CARE CENTER LTD (NPI# 1447449616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447449616 |
| Entity Type | Organization |
| Organization Name | EVERGREEN CARE CENTER LTD |
| Practice Address |
9760 S Kedzie Ave Suite 3 Evergreen Park IL 60805-3109 |
| Practice Telephone | 7084236209 |
| Practice Fax Number | 7084239021 |
| Mailing Telephone | 7084236209 |
| Mailing Fax Number | 7084239021 |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2010-07-19 |
| Authorized Official Name | DR. THOMAS JOSEPH (OWNER) |
| Authorized Official Telephone | 7084236209 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036084895 | 05 | |
| IL | RAIL ROAD MEDICARE | DA0131 | 01 |
| Street Address |
9760 S KEDZIE AVE SUITE 3 |
| City | EVERGREEN PARK |
| State | IL |
| Zip Code | 60805-3109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306836663 | Thomas Joseph | Internal Medicine | 9760 S Kedzie Ave, Suite 2, Evergreen Park, IL 60805-3109 | 2005-10-26 |
| 1518445543 | Christine Najarian | Physician Assistant | 9760 S Kedzie Ave, Evergreen Park, IL 60805-3109 | 2018-08-01 |
| 1760927057 | Wellcare Pharmacy LLC | Pharmacy | 9760 S Kedzie Ave, Evergreen Park, IL 60805-3109 | 2016-12-22 |
| 1457894768 | Rachel Brucas | Physician Assistant | 9760 S Kedzie Ave, Evergreen Park, IL 60805-3109 | 2016-11-18 |
| 1841587334 | Kristina Ann Johnson | Family Medicine | 9760 S Kedzie Ave, Suite 2, Evergreen Park, IL 60805-3109 | 2011-07-05 |
| 1033438460 | Health Solutions At Home Inc | Home Health | 9760 S Kedzie Ave, Suite 10b, Evergreen Park, IL 60805-3109 | 2010-05-25 |
| 1487987707 | Alicia Lopez | Pediatrics | 9760 S Kedzie Ave, Suite 11, Evergreen Park, IL 60805-3109 | 2009-09-18 |
| 1073746046 | George Thomas | Family Medicine | 9760 S Kedzie Ave, Suite 2, Evergreen Park, IL 60805-3109 | 2009-08-25 |
| 1891984068 | Park Primary Care Ltd | General Practice | 9760 S Kedzie Ave, Suite 2, Evergreen Park, IL 60805-3109 | 2007-10-23 |
| 1740488154 | Thomas Anthony Koludrovic | Dentist | 9760 S Kedzie Ave, Suite 4, Evergreen Park, IL 60805 | 2007-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487254603 | Cynthia Nicole Bucio | Pharmacist | 9400 S. Western, Evergreen Park, N/A 60805 | 2020-10-27 |
| 1124530456 | Foundations Counseling, LLC | Social Worker | 9730 S Western Ave Ste 215, Evergreen Park, IL 60805 | 2017-10-26 |
| 1184147886 | Luke Blaeser | Specialist/Technologist | 2856 W. 97th Pl., Evergreen Park, IL 60805 | 2017-07-25 |
| 1396193322 | Daniel Joseph Bierbaum Howard | Emergency Medicine | 2800 95th St, Emergency Department, Evergreen Park, IL 60805 | 2016-05-31 |
| 1588037873 | Lcr Primary Care LLC | Exclusive Provider Organization | 9237 S.pulaski, Ste. 2s, Evergreen Park, IL 60805 | 2015-11-09 |
| 1447639091 | Nancy Sanchez | Social Worker | 9832 S Utica Ave, Evergreen Park, IL 60805 | 2015-05-28 |
| 1629334743 | Harshad M. Mehta Md Sc | Psychiatry & Neurology | 2850 W. 95th Street, Suite 206, Evergreen Park, IL 60805 | 2012-04-03 |
| 1235407305 | Victoria T Adesina | Pharmacist | 8700 South Kedzie Ave, Evergreen Park, IL 60805 | 2011-12-05 |
| 1891072922 | Zahia-lena Refat Hussien | Pharmacist | 8700 S. Kedzie Ave, Evergreen Park, IL 60805 | 2011-11-03 |
| 1891079091 | Denise Adams | Occupational Therapy Assistant | 9217 S. Kedzie, Evergreen Park, IL 60805 | 2011-10-06 |
| Find all providers in zip 60805 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891984068 | Park Primary Care Ltd | General Practice | 9760 S Kedzie Ave, Suite 2, Evergreen Park, IL 60805-3109 | 2007-10-23 |
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| 1164067054 | League Corp. | General Practice | 515 N State St Fl 8, Chicago, IL 60654-9102 | 2019-11-14 |
| 1679129977 | Chronic Care Solutions LLC | General Practice | 3050 W Columbia Ave, Chicago, IL 60645-4006 | 2019-08-13 |
| 1205393972 | Midwest Medical LLC | General Practice | 2001 Midwest Rd Ste Ll22, Oak Brook, IL 60523-1316 | 2019-02-28 |
| 1306311725 | Genesis Integrative Medicine LLC | General Practice | 1881 S Randall Rd Ste C, Geneva, IL 60134-2532 | 2018-10-11 |
| Find all providers with the same taxonomy | ||||
| City | EVERGREEN PARK |
| Zip Code | 60805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.