Evergreen Place LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVERGREEN PLACE LLC

Practice address

3481 W 3100 S
West Valley City, UT 84119-2559

Phone

(801) 921-0070

NPI assigned

Oct 3, 2017

Last updated

Oct 3, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

82230602As reported in NPPES

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

Authorized official

Name

Jorge Gustavo Gonzalez Villarruel

Title

Owner

Phone

(801) 921-0070

Specialties & licenses 1

Addresses

Tax ID family

Evergreen Place LLC2 organizations share this tax ID, including this one

Part of

Evergreen Place LLC

Other organizations with this tax ID 1

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

• Evergreen Place LLC

  • Assisted Living Facility
  • Midvale, UT
  • NPI 1215456777
  NPD tax ID

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

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506988800000",
    "number": "1487164505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9193",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840479193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3481 W 3100 S",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841192559",
            "telephone_number": "801-921-0070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PLACE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "82230602",
        "enumeration_date": "2017-10-03",
        "last_updated": "2017-10-03",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ VILLARRUEL",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "GUSTAVO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-921-0070"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trisha Pauline Ermatinger, FNP
• Jaymen Ervin
• Patricia Esparza
• Cindy Andrea Esquivel, PTA
• Casey Lauren Estes, PA-C
• Reed Evers, MD
• Brian Howard Ewell, D.C.
• Robert Ewing
• Alyson Eyre, MD
• Jeelan Fall

• Assisted Living Facility in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Assisted Living Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2017; 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.