Evergreen at Petaluma, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

010000018 Issued in CA

Legal business name

EVERGREEN AT PETALUMA, L.L.C.

Doing business as

EmpRes Post Acute Rehabilitation

Practice address

300 Douglas St
Petaluma, CA 94952-2503

Phone

(707) 763-6887

Fax

(707) 763-0314

NPI assigned

May 4, 2006

Organization subpart

Yes

Parent organization

EMPRES CALIFORNIA HEALTHCARE, L.L.C.As reported in NPPES

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

Authorized official

Name

Brent Weil

Title

Ceo and Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EmpRes Post Acute Rehabilitation Doing business as

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1104874940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626729",
            "telephone_number": "360-892-6628",
            "fax_number": "360-882-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 DOUGLAS ST",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949522503",
            "telephone_number": "707-763-6887",
            "fax_number": "707-763-0314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT PETALUMA, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES CALIFORNIA HEALTHCARE, L.L.C.",
        "enumeration_date": "2006-05-04",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO AND MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000018",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZRO6120J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EmpRes Post Acute Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Violet Esquivel
• Timothy Hamilton Estes, HS
• Lydia E Estevez, P,T.
• Jaqueline Estrada-Bullard, RN
• Katherine Estrada
• Robin Exline, MS
• Molly Faahs
• Allison Fabian
• Stephanie Lynn Falkenberg, P.T.
• Leah Falsetto, MS RD

• Skilled Nursing Facility in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.