NPIMap

Organization Active NPI

Evergreen Senior Living,Inc

  • Assisted Living Facility
  • Woodland Hills, CA
National Provider Identifier
1073919783
Registry record updated Nov 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
197608576 Issued in CA
Legal business name
EVERGREEN SENIOR LIVING,INC
Practice address
23635 Collins St
Woodland Hills, CA 91367-5916
Phone
(818) 331-2320
Fax
(818) 704-7339
NPI assigned
Nov 6, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2014

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

Authorized official

Name
Mr. Jacob FahimipourNPI 1912316365
Title
Administrator
Phone
(818) 331-2320

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 197608576 CA Primary

Addresses

Primary practice location

23635 Collins St
Woodland Hills, CA 91367-5916

Mailing address

23635 Collins St
Woodland Hills, CA 91367-5916
Phone (818) 331-2320

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415232000000",
    "number": "1073919783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23635 COLLINS ST",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913675916",
            "telephone_number": "818-331-2320",
            "fax_number": "818-704-7339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23635 COLLINS ST",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913675916",
            "telephone_number": "818-331-2320",
            "fax_number": "818-704-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SENIOR LIVING,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2014-11-06",
        "status": "A",
        "authorized_official_last_name": "FAHIMIPOUR",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "818-331-2320",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "197608576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; 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.