NPIMap

Organization Active NPI

Evergreen Mesa Christian, L.L.C.

  • Skilled Nursing Facility
  • Mesa, AZ
National Provider Identifier
1114975810
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCI-2629 Issued in AZ
Legal business name
EVERGREEN MESA CHRISTIAN, L.L.C.
Doing business as
Evergreen Mesa Christian Health and Rehabilitation Center
Practice address
255 W Brown Rd
Mesa, AZ 85201-3404
Phone
(480) 833-3988
Fax
(480) 833-7122
NPI assigned
May 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Andrew V. Martini
Title
Manager
Phone
(360) 892-6628

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NCI-2629 AZ Primary

Addresses

Primary practice location

255 W Brown Rd
Mesa, AZ 85201-3404

Mailing address

4601 NE 77TH Ave
Suite 300
Vancouver, WA 98662-6729
Phone (360) 892-6628

Other identifiers 1

IdentifierTypeStateIssuer
748791MedicaidAZ

Other names 1

  • Evergreen Mesa Christian Health and Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Mesa Christian Health and Rehabilitation Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114975810",
    "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": "255 W BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852013404",
            "telephone_number": "480-833-3988",
            "fax_number": "480-833-7122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MESA CHRISTIAN, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINI",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-892-6628",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-2629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "748791",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Mesa Christian Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.