Everglow Residences LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVERGLOW RESIDENCES LLC

Practice address

984 Blue Jay Way
Forney, TX 75126-8307

Phone

(214) 836-3862

NPI assigned

Oct 24, 2024

Organization subpart

No

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

Authorized official

Name

Alvine Kombem

Title

Mrs

Phone

(267) 252-8144

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1729728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1427879154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "984 BLUE JAY WAY",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751268307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "984 BLUE JAY WAY",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751268307",
            "telephone_number": "214-836-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGLOW RESIDENCES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-24",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "KOMBEM",
        "authorized_official_first_name": "ALVINE",
        "authorized_official_title_or_position": "MRS",
        "authorized_official_telephone_number": "267-252-8144"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Forney, TX
• Providers in Forney, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.