OrganizationEvergreen Homecare Service Of Ny IncHome HealthAgenciesPractice Address154-08 Northern Blvd, Suite 2a, Flushing, NY 11354(718) 321-2113PECOS EnrollmentBased on the most recent information from CMS, provider Evergreen Homecare Service Of Ny Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1437714888Provider TypeOrganizationFull NameEvergreen Homecare Service Of Ny IncSubpartNoEnumeration Date5/1/2019Last Updated7/29/2022Contact InformationPractice LocationPractice Address154-08 Northern Blvd, Suite 2a, Flushing, NY 11354Phone(718) 321-2113Fax(718) 925-4105Mailing LocationMailing Address154-08 Northern Blvd, Suite 2a, Flushing, NY 11354Phone(718) 321-2113Fax(718) 925-4105Authorized OfficialNameKoo, Hyunjong (President)Phone(718) 321-2113Provider TaxonomiesCodeDescriptionLicenseCode251E00000XPrimaryDescriptionHome HealthAgenciesLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID04345855DescriptionMedicaidIssuerUnlistedNew York