NPIMap

Organization Active NPI

Evergreen Place LLC

  • Assisted Living Facility
  • Midvale, UT
National Provider Identifier
1215456777
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
EVERGREEN PLACE LLC
Practice address
163 E 7800 S
Midvale, UT 84047-2612
Phone
(801) 921-0070
NPI assigned
Sep 15, 2017
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Jorge Gustavo Gonzalez Villarruel
Title
Owner
Phone
(801) 921-0070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

163 E 7800 S
Midvale, UT 84047-2612

Mailing address

PO Box 9193
Midvale, UT 84047-9193
Phone (801) 921-0070

Other practice location 1

3481 W 3100 S
West Valley, UT 84119-2559
Phone (801) 921-0070

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Place LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1215456777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9193",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840479193",
            "telephone_number": "801-921-0070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 E 7800 S",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840472612",
            "telephone_number": "801-921-0070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3481 W 3100 S",
            "address_purpose": "LOCATION",
            "city": "West Valley",
            "state": "UT",
            "postal_code": "841192559",
            "country_code": "US",
            "telephone_number": "801-921-0070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVERGREEN PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ VILLARRUEL",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "GUSTAVO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-921-0070"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midvale, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.