Evergreen at Mesa (Alf), L.L.C.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALC-5063 Issued in AZ

Legal business name

EVERGREEN AT MESA (ALF), L.L.C.

Doing business as

Mesa Christian Residential Care Center

Practice address

215 W Brown Rd
Mesa, AZ 85201-3415

Phone

(480) 668-6118

Fax

(480) 461-1552

NPI assigned

Jul 11, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Anne Nipp

Title

Manager

Phone

(360) 892-6618

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mesa Christian Residential Care Center Doing business as

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

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184112000000",
    "number": "1093914004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 W BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013415",
            "telephone_number": "480-668-6118",
            "fax_number": "480-461-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013415",
            "telephone_number": "480-668-6118",
            "fax_number": "480-461-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT MESA (ALF), L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2007-07-11",
        "status": "A",
        "authorized_official_last_name": "NIPP",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-892-6618",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "ALC-5063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "937427",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mesa Christian Residential Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Justin Everett
• Renee Nicole Everett, R.N.
• Sue Thayer Everett, MA CCC SLP
• Tarynn Francis Everett, PA-C
• Willie Everett
• Evergreen at Mesa, L.L.C. (Evergreen Valley Health and Rehabilitation Center)
• Evergreen Hospice, LLC.
• Evergreen Mesa Christian, L.L.C. (Evergreen Mesa Christian Health and Rehabilitation Center)
• Evergrove Integrative Health PLLC
• Evermind Behavioral Health

• Assisted Living Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; 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.