NPIMap

Organization Active NPI

Evergreen Living Home #4

  • Assisted Living Facility
  • Leicester, NC
National Provider Identifier
1427255264
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
FCL-011-248 Issued in NC
Legal business name
EVERGREEN LIVING HOME #4
Practice address
230 Country Time Circle
Leicester, NC 28748
Phone
(828) 683-8884
NPI assigned
Jun 27, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Linda Lea
Title
Administrator
Phone
(828) 279-9592

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X FCL-011-248 NC Primary

Addresses

Primary practice location

230 Country Time Circle
Leicester, NC 28748

Mailing address

PO Box 1808
Leicester, NC 28748-1808

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Living Home 46 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1182902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1427255264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1808",
            "city": "LEICESTER",
            "state": "NC",
            "postal_code": "287481808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 COUNTRY TIME CIRCLE",
            "city": "LEICESTER",
            "state": "NC",
            "postal_code": "28748",
            "telephone_number": "828-683-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN LIVING HOME #4",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEA",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "828-279-9592",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "FCL-011-248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leicester, NC

Sources for this page

  • 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.