Evergreen at Heartwood Avenue, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

010000020 Issued in CA

Legal business name

EVERGREEN AT HEARTWOOD AVENUE, L.L.C.

Doing business as

Heartwood Avenue Healthcare

Practice address

1044 Heartwood Ave
Vallejo, CA 94591-5637

Phone

(707) 643-2267

Fax

(707) 643-5209

NPI assigned

May 4, 2006

Organization subpart

Yes

Parent organization

EMPRES CALIFORNIA HEALTHCARE, LLCAs reported in NPPES

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

Authorized official

Name

Brent Weil

Title

Ceo and Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Heartwood Avenue Healthcare Doing business as

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1245288083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626736",
            "telephone_number": "360-892-6628",
            "fax_number": "360-882-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 HEARTWOOD AVE",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945915637",
            "telephone_number": "707-643-2267",
            "fax_number": "707-643-5209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT HEARTWOOD AVENUE, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES CALIFORNIA HEALTHCARE, LLC",
        "enumeration_date": "2006-05-04",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO AND MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55184H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heartwood Avenue Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Matteo Evangelista
• Aliyah Denali Evans
• Gary D. Evans, MD
• Sedalia Evans
• Solita Vashone Evans
• Evergreen at Springs Road, L.L.C.
• Tosan Adaze Elise Eweka
• Marsha Lee Ewig, MSW
• Excel Therapy Group, Inc.
• Exclusive Enterprises Inc

• Skilled Nursing Facility in Vallejo, CA
• Providers in Vallejo, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.