Evergreen Haven LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVERGREEN HAVEN LLC

Practice address

445 E 10TH St
Baxter Springs, KS 66713-1614

Phone

(620) 304-2108

Fax

(620) 304-2109

NPI assigned

May 12, 2025

Organization subpart

No

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

Authorized official

Name

Mr. Larry Robert Higginbotham

Title

Owner

Phone

(417) 850-3063

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1747008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747008000000",
    "number": "1104616002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92",
            "city": "RACINE",
            "state": "MO",
            "postal_code": "648580092",
            "telephone_number": "417-850-3063",
            "fax_number": "620-304-2109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 E 10TH ST",
            "city": "BAXTER SPRINGS",
            "state": "KS",
            "postal_code": "667131614",
            "telephone_number": "620-304-2108",
            "fax_number": "620-304-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HAVEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-12",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAM",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-850-3063",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; 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.