Evergreen Woods

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2189C Issued in CT

Legal business name

EVERGREEN WOODS

Practice address

88 Notch Hill Rd
North Branford, CT 06471-1846

Phone

(203) 483-3205

Fax

(203) 483-3202

NPI assigned

Nov 7, 2005

Last updated

Aug 22, 2020By 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

Ms. Constance Waldinger, RN, ADMINISTRATOR

Title

Executive Director

Phone

(203) 488-8000

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417938580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 NOTCH HILL RD",
            "city": "NORTH BRANFORD",
            "state": "CT",
            "postal_code": "064711846",
            "telephone_number": "203-483-3205",
            "fax_number": "203-483-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 NOTCH HILL RD",
            "city": "NORTH BRANFORD",
            "state": "CT",
            "postal_code": "064711846",
            "telephone_number": "203-483-3205",
            "fax_number": "203-483-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WOODS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALDINGER",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-488-8000",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN, ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CT",
            "license": "2189C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY LICENSE NUMBER",
            "identifier": "2189C",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna Marie Dearborne
• Donielle Didiano, LCSW
• Sandra Lee Dizenzo, COTA/L
• Jamie Elena Dynderski, LCSW
• Madeline Eldredge
• Evergreen Woods Retirement, LLC (Evergreen Woods)
• Candace Lynn Fazio
• Jessica Guivas, LCSW
• Hannah Isacson D.C. LLC
• Kathleen Hassen Stack, PT

• Skilled Nursing Facility in North Branford, CT
• Providers in North Branford, CT by specialty
• Skilled Nursing Facility in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.