Evergreen Place LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

1075244 Issued in MN

Legal business name

EVERGREEN PLACE LLC

Practice address

23299 285TH Ave
Akeley, MN 56433-8020

Phone

(218) 652-6702

Fax

(218) 652-6710

NPI assigned

Nov 19, 2014

Last updated

Nov 19, 2014By 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. Beth Ann McGarry, LNHANPI 1558765701

Title

Administrator

Phone

(218) 652-6702

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Beth Ann McGarry

  • Case Manager/Care Coordinator
  • Akeley, MN
  • NPI 1558765701
  NPD (past) Authorized official

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

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416355200000",
    "number": "1326445388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23299 285TH AVE",
            "city": "AKELEY",
            "state": "MN",
            "postal_code": "564338020",
            "telephone_number": "218-652-6702",
            "fax_number": "218-652-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23299 285TH AVE",
            "city": "AKELEY",
            "state": "MN",
            "postal_code": "564338020",
            "telephone_number": "218-652-6702",
            "fax_number": "218-652-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2014-11-19",
        "status": "A",
        "authorized_official_last_name": "MCGARRY",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-652-6702",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MN",
            "license": "1075244",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "MN",
            "license": "1075464-1HCBS",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rae Bayman
• Rebecca Grosskreutz
• Judith Ann Malmskog, LICSW
• Beth Ann McGarry
• Emily Neely
• Ardella Vandyke, LICSW

• Adult Care Home Facility in Akeley, MN
• Providers in Akeley, MN by specialty
• Adult Care Home Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2014; 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.