Evergreen Supported Living, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

EVERGREEN SUPPORTED LIVING, LLC

Practice address

5150 E Main St Ste 102
Whitehall, OH 43213-2441

Phone

(614) 205-9982

NPI assigned

Jun 25, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Anta Moore, DBA, MSN, CNP

Title

Ceo

Phone

(614) 205-9982

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Anta Fall Sow, CNP

  • Family Nurse Practitioner
  • Canal Winchester, OH
  • NPI 1003128786
  NPD (past)

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

{
    "created_epoch": "1466812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466812800000",
    "number": "1235580820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 E MAIN ST STE 102",
            "city": "WHITEHALL",
            "state": "OH",
            "postal_code": "432132441",
            "telephone_number": "614-205-9982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 E MAIN ST STE 102",
            "city": "WHITEHALL",
            "state": "OH",
            "postal_code": "432132441",
            "telephone_number": "614-205-9982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SUPPORTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-25",
        "last_updated": "2016-06-25",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "ANTA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "614-205-9982",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DBA, MSN, CNP"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ediye Joy Enoobong, LPN
• Heather Erhardt
• Lashawn Ervin
• Brittany Eubanks, BSW, LSW
• Matt Evans
• Lindsey Nichole Eversole, MED, LPCC
• Alison Nicole Ezell
• Andrew Fair
• Jordan Falk
• Nigel Fambro, RN

• In Home Supportive Care Agency in Whitehall, OH
• Providers in Whitehall, OH by specialty
• In Home Supportive Care Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2016; 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.