45D2094565 CLIA NUMBER - EVERGREEN PRIVATE CARE

Laboratory Demographics

CLIA Number: 45D2094565

Facility Name: EVERGREEN PRIVATE CARE

Facility Address:
16818 NORTH ELDRIDGE PARKWAY
TOMBALL, TX
ZIP 77377
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Facility Phone Number: 281 320-1856

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1821350638

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 45D2094565
LAB Type Home Health Agency
Facility Name EVERGREEN PRIVATE CARE
Street 16818 NORTH ELDRIDGE PARKWAY
City TOMBALL
State TX
ZIP 77377
Phone 281 320-1856
CertificateType 4
CertificateEffectiveDate 4/21/2023
CertificateExpirationDate 4/20/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024