Evergreen Dickinson, LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

License

8054A Issued in ND

Legal business name

EVERGREEN DICKINSON, LLC

Practice address

2143 6TH Ave W
Dickinson, ND 58601-2700

Phone

(701) 483-6606

NPI assigned

Jun 26, 2007

Last updated

Nov 18, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Vickie Cofer

Title

Asst. Director

Phone

(701) 483-6606

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226966400000",
    "number": "1316143175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2143 6TH AVE W",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586012700",
            "telephone_number": "701-483-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2143 6TH AVE W",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586012700",
            "telephone_number": "701-483-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DICKINSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2008-11-18",
        "status": "A",
        "authorized_official_last_name": "COFER",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "ASST. DIRECTOR",
        "authorized_official_telephone_number": "701-483-6606",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "ND",
            "license": "8054A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030765",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2008; 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.