Evergreen at Talbot Road, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1311 Issued in WA

Legal business name

EVERGREEN AT TALBOT ROAD, L.L.C.

Practice address

4430 Talbot Rd S
Renton, WA 98055-6218

Phone

(425) 226-7500

Fax

(425) 226-4195

NPI assigned

May 5, 2006

Organization subpart

Yes

Parent organization

EMPRES WASHINGTON HEALTHCARE, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brent Weil

Title

Ceo and Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Talbot Center for Rehabilitation and Healthcare Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1013965722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626736",
            "telephone_number": "360-892-6628",
            "fax_number": "360-882-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 TALBOT RD S",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556218",
            "telephone_number": "425-226-7500",
            "fax_number": "425-226-4195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT TALBOT ROAD, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES WASHINGTON HEALTHCARE, LLC",
        "enumeration_date": "2006-05-05",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO AND MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "1311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4113114",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Talbot Center for Rehabilitation and Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Corynne Adele Evans
• Shanae Laquich Evans, MS, LMHCA
• Nancy J Eveleth, LMHC
• Everblossom Health LLC
• Evercare Healths LLC
• Evergreen Pediatric Nutrition LLC
• Evergreen Treatment Services
• Everlasting Smiles 4 U
• Amanda Everly, LMHC
• Martha Ewer

• Skilled Nursing Facility in Renton, WA
• Providers in Renton, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.