Evergreen Valley Nursing Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0901301N Issued in NY

Legal business name

EVERGREEN VALLEY NURSING HOME

Practice address

8 Bushey Blvd.
Plattsburgh, NY 12901-3785

Phone

(518) 563-3261

Fax

(518) 562-1367

NPI assigned

Sep 29, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Ephraim Zagelbaum

Title

Ceo

Phone

(914) 597-7600

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Evergreen Valley Nursing Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• PRNC Operating LLC

  • Adult Day Care Clinic/Center
  • Plattsburgh, NY
  • NPI 1881146009
  NPD tax ID

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442793600000",
    "number": "1477540193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 BUSHEY BLVD",
            "city": "MORRISONVILLE",
            "state": "NY",
            "postal_code": "129013785",
            "telephone_number": "518-563-3261",
            "fax_number": "518-562-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 BUSHEY BLVD.",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129013785",
            "telephone_number": "518-563-3261",
            "fax_number": "518-562-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN VALLEY NURSING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2015-09-21",
        "status": "A",
        "authorized_official_last_name": "ZAGELBAUM",
        "authorized_official_first_name": "EPHRAIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "914-597-7600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "0901301N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00308801",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02329757",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amr Essa, MD
• Aaron Esterson, MD
• Cheryl Jasmin Eustaquio, M.D.
• Debra Everett
• Evergreen Valley Nursing Home
• Charles A Everly, M.D.
• Phoebe L Everson, MD
• Eye Care for the Adirondacks Associates in Ophthalmology PC
• Eye Care for the Adirondacks Associates in Ophthalmology, PC
• Jennifer Amber Facteau-Rabideau, NP

• Skilled Nursing Facility in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2015; 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.