Evergreen Terrace Assisted Living

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

23D1102189 Issued in MI

Legal business name

EVERGREEN TERRACE ASSISTED LIVING

Doing business as

Evergreen Terrace Assisted Living - Laboratory

Practice address

801 Fuller Ave
Big Rapids, MI 49307-2106

Phone

(231) 527-1050

NPI assigned

Mar 31, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Thomas Nobel

Title

President

Phone

(231) 527-1050

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Terrace Assisted Living - Laboratory Doing business as

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

CLIA laboratory certificates

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

{
    "created_epoch": "1269993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300320000000",
    "number": "1235454356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 FULLER AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072106",
            "telephone_number": "231-527-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 FULLER AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072106",
            "telephone_number": "231-527-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN TERRACE ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-31",
        "last_updated": "2011-03-17",
        "status": "A",
        "authorized_official_last_name": "NOBEL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-527-1050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "23D1102189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Terrace Assisted Living - Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David G Elwell, M.D.
• Noah Emerson, MA, SLC, NCC
• John Campbell Erwin, LLMSW
• Amy Frances Evans, LMSW
• Evergreen Physical Therapy Limited Partnership
• Evergreen Terrace Assisted Living
• Eyeglass Acquisitions, Inc. (Smeelink Optical)
• Jazlyn K Ezell
• Amber Fate, CPRC
• Melanie May Fawbush

• Clinical Medical Laboratory in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Clinical Medical Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; 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.