Evergreen Manor Retirement Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL8760 Issued in FL

Legal business name

EVERGREEN MANOR RETIREMENT HOME

Practice address

3297 State Road 580
Safety Harbor, FL 34695-4929

Phone

(727) 724-3776

NPI assigned

Nov 21, 2008

Organization subpart

No

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

Authorized official

Name

Yee-Chun Tan Kapusinsky, RD

Title

Administrator

Phone

(727) 480-2180

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1227225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227225600000",
    "number": "1366697153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3297 STATE ROAD 580",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "346954929",
            "telephone_number": "727-724-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3297 STATE ROAD 580",
            "city": "SAFETY HARBOR",
            "state": "FL",
            "postal_code": "346954929",
            "telephone_number": "727-724-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MANOR RETIREMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-21",
        "last_updated": "2008-11-21",
        "status": "A",
        "authorized_official_last_name": "KAPUSINSKY",
        "authorized_official_first_name": "YEE-CHUN",
        "authorized_official_middle_name": "TAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "727-480-2180",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL8760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gwen B Enfield, RD, CDE
• Kerry Englert, D.O.
• Esther L Klein, PA
• Marie V Evangelisti, LMT
• Robert A Evans, PH.D.
• Ezra S Elkayam MD PA
• Family Massage Center, Inc
• Family Psychology Associates Inc
• Muhammad H. Farooqi, M.D.
• Patricia J Farrell, ARNP

• Assisted Living Facility in Safety Harbor, FL
• Providers in Safety Harbor, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.