Evergreen Senior Home Care at Corona LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVERGREEN SENIOR HOME CARE AT CORONA LLC

Practice address

826 Paseo Grande
Corona, CA 92882-2841

Phone

(951) 893-0859

NPI assigned

Nov 18, 2024

Organization subpart

No

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

Authorized official

Name

Tamanna Rahman

Title

Administrator

Phone

(951) 893-0859

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1215752993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27009",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928090100",
            "telephone_number": "951-893-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 PASEO GRANDE",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928822841",
            "telephone_number": "951-893-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SENIOR HOME CARE AT CORONA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A",
        "authorized_official_last_name": "RAHMAN",
        "authorized_official_first_name": "TAMANNA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "951-893-0859"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Corona, CA
• Providers in Corona, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.