Evergreen Supported Living

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

EVERGREEN SUPPORTED LIVING

Practice address

305 Flora St
Bellingham, WA 98225-4430

Phone

(360) 671-5898

Fax

(360) 922-0648

NPI assigned

Jun 2, 2022

Organization subpart

No

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

Authorized official

Name

Zay Aidan Smith McShaneNPI 1548909922

Title

Executive Director

Phone

(360) 671-5898

Specialties & licenses 6

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Zay Aidan Smith McShane

  • Day Training/Habilitation Specialist
  • Bellingham, WA
  • NPI 1548909922
  NPD Authorized official

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

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654128000000",
    "number": "1124767587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 FLORA ST",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982254430",
            "telephone_number": "360-671-5898",
            "fax_number": "360-922-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 FLORA ST",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982254430",
            "telephone_number": "360-671-5898",
            "fax_number": "360-922-0648"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1970 Fraser St Apt 106",
            "address_purpose": "LOCATION",
            "city": "Bellingham",
            "state": "WA",
            "postal_code": "982293794",
            "country_code": "US",
            "telephone_number": "360-671-5898",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN SUPPORTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-02",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A",
        "authorized_official_last_name": "MCSHANE",
        "authorized_official_first_name": "ZAY",
        "authorized_official_middle_name": "AIDAN SMITH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-671-5898"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evergreen AIDS Foundation
• Evergreen at Bellingham, L.L.C.
• Evergreen Community & Support Services LLC
• Evergreen North Cascades Health & Rehab Ctr.
• Evergreen Psychiatry, LLC
• Matthew H Evoy Jr., CDP, CCC
• Jeannette Marie Evraets, RN LAC
• Lucinda Ewing, RN
• Excel Physical Therapy Inc.
• Expanding Visions Counseling PLLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.