Evergreen Life Services of Florida, Inc.

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

EVERGREEN LIFE SERVICES OF FLORIDA, INC.

Practice address

2101 Starkey Rd
Largo, FL 33771-5340

Phone

(727) 748-6203

NPI assigned

Sep 19, 2019

Organization subpart

No

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

Authorized official

Name

Merlon Kent Craft

Title

Evp/Cfo

Phone

(318) 949-5515

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611705600000",
    "number": "1093365215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 80",
            "city": "HAUGHTON",
            "state": "LA",
            "postal_code": "710379488",
            "telephone_number": "318-949-5515",
            "fax_number": "318-949-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 STARKEY RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337715340",
            "telephone_number": "727-748-6203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN LIFE SERVICES OF FLORIDA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-19",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A",
        "authorized_official_last_name": "CRAFT",
        "authorized_official_first_name": "MERLON",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "EVP/CFO",
        "authorized_official_telephone_number": "318-949-5515"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Largo, FL
• Providers in Largo, FL by specialty
• Developmentally Disabled Services Day Training Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.