Evergreen Residential Care

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

2919 Issued in UT

Legal business name

EVERGREEN RESIDENTIAL CARE

Practice address

2374 Evergreen Ave
Salt Lake City, UT 84109-3006

Phone

(801) 272-2601

Fax

(801) 278-3697

NPI assigned

Dec 27, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Melvin Darcy Forsman

Title

Owner

Phone

(801) 272-2601

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487719662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2374 EVERGREEN AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841093006",
            "telephone_number": "801-272-2601",
            "fax_number": "801-278-3697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2374 EVERGREEN AVE",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841093006",
            "telephone_number": "801-272-2601",
            "fax_number": "801-278-3697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RESIDENTIAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORSMAN",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_middle_name": "DARCY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-272-2601",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "UT",
            "license": "2919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kira Shayn Evensen
• Bret Everding
• Anna Ruth Everett, PA
• Paris Everett
• Evergreen at Holladay, L.L.C.
• Everreach ABA Utah LLC
• Jacob Evertsen, BEHAVIOR TECHNICIAN
• Christopher M. Evola, MD
• Evolution Academy of Utah LLC
• Evolutionary Healthcare LLC

• Assisted Living Facility in Salt Lake City, UT
• Providers in Salt Lake 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 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.