EVERGREEN HEALTH CARE & GROUP HOME LLC

Home Health

Code: 251E00000X

Nursing Care

Code: 251J00000X

Community/Behavioral Health

Code: 251S00000X

In Home Supportive Care

Code: 253Z00000X

Clinic/Center — Mental Health (Including Community Mental Health Center)

Code: 261QM0801X

Clinic/Center — Adolescent and Children Mental Health

Code: 261QM0855X

Assisted Living Facility

Code: 310400000X

Skilled Nursing Facility

Code: 314000000X