The Evergreens, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0073 Issued in NC

Legal business name

THE EVERGREENS, INC.

Practice address

4007 W Wendover Ave
Greensboro, NC 27407-1904

Phone

(336) 292-8620

Fax

(336) 854-7122

NPI assigned

Jul 26, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Marilyn Gardner, LNHA

Title

Administrator

Phone

(336) 292-8620

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Evergreens Senior Healthcare System Other name

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1366465403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4007 W WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071904",
            "telephone_number": "336-292-8620",
            "fax_number": "336-854-7122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4007 W WENDOVER AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071904",
            "telephone_number": "336-292-8620",
            "fax_number": "336-854-7122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EVERGREENS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-292-8620",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "NH0073",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405016",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS INS PROVIDER NO",
            "identifier": "40251",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC PROVIDER NO",
            "identifier": "00829",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406162",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreens Senior Healthcare System",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Skilled Nursing Facility in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; 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.