Evergreen Living #4
Organization Active NPI Adult Care Home Facility · Leicester, NC
NPI 1255452017 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1255452017
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Care Home Facility 311ZA0620X
- License
- FCL-011-196 (NC)
- Legal business name
- EVERGREEN LIVING #4
- Practice address
- 351 Family Ridge Road
Leicester, NC 28748 - Phone
- (828) 779-5588
- NPI assigned
- Apr 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Young S Lee
- Title
- Owner
- Phone
- (828) 779-5588
Corporate family (same tax ID) 18
National Provider Directory
- Tax ID family
- Evergreen Living 4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | FCL-011-196 | NC | Yes |
Addresses
Primary practice location
351 Family Ridge Road
Leicester, NC 28748
Mailing address
PO Box 2077
Leicester, NC 28748-2077
Phone (828) 779-5588
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7805221 | Medicaid | NC |
Other providers in Leicester, NC
- Kristen Duchac
- Erin McCord Duckett
- Elderflower Counseling, PLLC
- Amanda Emery
- Theresa Emmanuel
- Evergreen Living #4
- Evergreen Living #5
- Evergreen Living #5
- Evergreen Living #6
- Evergreen Living #7
All providers in Leicester, NC · Adult Care Home Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.