NPIMap

Organization Active NPI

Evergreen Woods Retirement, LLC

Doing business as Evergreen Woods

  • Skilled Nursing Facility
  • North Branford, CT
National Provider Identifier
1508317223
Registry record updated Apr 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EVERGREEN WOODS RETIREMENT, LLC
Doing business as
Evergreen Woods
Practice address
88 Notch Hill Rd
North Branford, CT 06471-1846
Phone
(203) 488-8000
NPI assigned
Oct 18, 2016
Last updated
Apr 26, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2017

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

Authorized official

Name
Mr. Donald O Thompson Jr.
Title
Ceo
Phone
(704) 246-1620

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

88 Notch Hill Rd
North Branford, CT 06471-1846

Mailing address

3530 Toringdon Way
Suite 204
Charlotte, NC 28277-3431
Phone (704) 246-1620

Other names 1

  • Evergreen Woods Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170111002442 CT Part A Provider - Skilled Nursing Facility 9032490784 Practice locations: North Branford, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508317223. Details of each certification follow.

Skilled nursing facility certification: CCN 075362

Legal name
EVERGREEN WOODS RETIREMENT LLC
Doing business as
EVERGREEN WOODS
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Oct 16, 1991
Last certification
Dec 22, 2023
Beds
50
Ownership / control type
Corporation
Multi-facility organization
,AXWELL GROUP/SENIOR LIVING COMMUNITIES
Organization structure
LLCProprietary
Enrollment address
88 Notch Hill Rd
North Branford, CT 06471-1846
Nursing home name
EVERGREEN WOODS
Affiliated entity
SENIOR LIVING COMMUNITIES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Evergreen WoodsCCN 075362 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Oct 16, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5041.0 residents per day on average
Chain
Senior Living Communities9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

3530 Toringdon Way
Ste 204
Charlotte, NC 28277

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kimberly Glerum Individual Operational/Managerial Control Feb 1, 2025
Adp of the SNF Apr 4, 2025
Amanda Welch Individual Operational/Managerial Control Jul 10, 2023
Adp of the SNF Mar 27, 2025
Benjamin M. Thompson Individual Operational/Managerial Control Jul 1, 2022
Indirect Ownership Interest Jan 1, 2021 37.5%
Joshua E. Thompson Individual Indirect Ownership Interest Jan 1, 2021 25%
Donald Thompson Individual 5% Or Greater Indirect Ownership InterestManager Jun 27, 2016 50%
Managing Control - Governing BodyManager Jun 27, 2016
Indirect Ownership Interest Jun 27, 2016 50%
Brenda U. Thompson 2020 Irrevocable Trust Dated December 30, 2020 Organization, Charlotte, NC Owned by another organization or individual Indirect Ownership Interest Jan 1, 2021 25%
Senior Living Commuities LLC Organization, Charlotte, NC LLC Operational/Managerial Control Jun 27, 2016
Direct Ownership Interest Jun 27, 2016 100%
Brenda U. Thompson 2020 Irrevocable Trust Dated December 30, 2020 Organization, Charlotte, NC Owned by another organization or individual Indirect Ownership Interest Jan 1, 2021 25%
Maxwell Group, Inc. Organization, Charlotte, NC Management services company Operational/Managerial Control Jan 23, 2025
Adp of the SNF Jan 23, 2025
Nhi-Reit of Evergreen LLC Organization, Murfreesboro, TN LLC Adp of the SNF Nov 8, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493164800000",
    "number": "1508317223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3530 TORINGDON WAY",
            "address_2": "SUITE 204",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282773431",
            "telephone_number": "704-246-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 NOTCH HILL RD",
            "city": "NORTH BRANFORD",
            "state": "CT",
            "postal_code": "064711846",
            "telephone_number": "203-488-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN WOODS RETIREMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-18",
        "last_updated": "2017-04-26",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-246-1620",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Woods",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Branford, CT

Sources for this page

Verify at the official NPI Registry.