Evergreen at Ely, L.L.C.

Key facts

NPI

1093339947

Entity type

Organization (NPI type 2)

Primary specialty

Skilled Nursing Facility 314000000X

Legal business name

EVERGREEN AT ELY, L.L.C.

Practice address

1500 Avenue G
Ely, NV 89301-2539

Phone

(775) 289-8801

Fax

(775) 289-3208

NPI assigned

Jun 5, 2020

Organization subpart

No

Authorized official

Name

James Robert Preimesberger

Title

Manager

Phone

(213) 220-4808

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Evergreen at Ely, L.L.C. Skilled Nursing Facility · Ely, NV · NPI 1750339131
  NPD member Member Of

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• White Pine Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 5, 2020.

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591315200000",
    "number": "1093339947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 AVENUE G",
            "city": "ELY",
            "state": "NV",
            "postal_code": "893012539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 AVENUE G",
            "city": "ELY",
            "state": "NV",
            "postal_code": "893012539",
            "telephone_number": "775-289-8801",
            "fax_number": "775-289-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT ELY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-05",
        "last_updated": "2020-06-05",
        "certification_date": "2020-06-05",
        "status": "A",
        "authorized_official_last_name": "PREIMESBERGER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "213-220-4808"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1917920",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Pine Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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All providers in Ely, NV · Skilled Nursing Facility in Nevada