Evergreen Community Homes Inc

Primary specialty

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

Legal business name

EVERGREEN COMMUNITY HOMES INC

Doing business as

Evergreen Community Homes Inc

Practice address

13 Broadbridge Rd
Rosedale, MD 21237-1558

Phone

(443) 642-9933

NPI assigned

Feb 1, 2022

Last updated

Feb 1, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Ngozi Gloria Wilkens, NURSE

Title

Administrator

Phone

(443) 642-9933

Specialties & licenses 1

Addresses

Other names 1

• EVERGREEN COMMUNITY HOMES INC Doing business as

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

{
    "created_epoch": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1205589173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 BROADBRIDGE RD",
            "city": "ROSEDALE",
            "state": "MD",
            "postal_code": "212371558",
            "telephone_number": "443-642-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 BROADBRIDGE RD",
            "city": "ROSEDALE",
            "state": "MD",
            "postal_code": "212371558",
            "telephone_number": "443-642-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN COMMUNITY HOMES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "WILKENS",
        "authorized_official_first_name": "NGOZI",
        "authorized_official_middle_name": "GLORIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "443-642-9933",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NURSE"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EVERGREEN COMMUNITY HOMES INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.