Evergreen Manor, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

36405 Issued in ME

Legal business name

EVERGREEN MANOR, INC

Practice address

328 North St
Saco, ME 04072-1814

Phone

(207) 282-5161

Fax

(207) 282-5163

NPI assigned

Dec 11, 2006

Last updated

Apr 20, 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

Mr. Glen G Cyr

Title

VP of Finance

Phone

(207) 786-3554

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1356401202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 LISBON ST",
            "address_2": "2ND FLOOR",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042407248",
            "telephone_number": "207-786-3554",
            "fax_number": "207-786-8507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "328 NORTH ST",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040721814",
            "telephone_number": "207-282-5161",
            "fax_number": "207-282-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MANOR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "CYR",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "207-786-3554",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ME",
            "license": "36405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Saco, ME
• Providers in Saco, ME by specialty
• Skilled Nursing Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.