Evergreen Woods Retirement, LLC
Organization Active NPI Skilled Nursing Facility · North Branford, CT
NPI 1508317223 · NPPES record last updated Apr 26, 2017
Key facts
- NPI
- 1508317223
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- EVERGREEN WOODS RETIREMENT, LLC
- Practice address
- 88 Notch Hill Rd
North Branford, CT 06471-1846 - Phone
- (203) 488-8000
- NPI assigned
- Oct 18, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Donald O Thompson Jr.
- Title
- Ceo
- Phone
- (704) 246-1620
Owners & managing parties with NPI records 1
Facilities with the same owner 10
Affiliated clinicians 4
-
Alyse Michelle Cox, ARPN
-
Ann R Datunashvili, M.D.
-
Loren Shari Greenberg, MS, MD
Medicare Care Compare: Nursing home
- Listed as
- Evergreen Woods
- 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
- Active
- Certified beds
- 50 · 41.0 residents per day on average
- Chain
- Senior Living Communities
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
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
- LLC · Proprietary
- Enrollment address
- 88 Notch Hill Rd
North Branford, CT 06471-1846 - Nursing home name
- EVERGREEN WOODS
- Affiliated entity
- SENIOR LIVING COMMUNITIES
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Glerum |
Operational/Managerial Control | Feb 1, 2025 | |
| Adp of the SNF | Apr 4, 2025 | ||
| Amanda Welch |
Operational/Managerial Control | Jul 10, 2023 | |
| Adp of the SNF | Mar 27, 2025 | ||
| Benjamin M. Thompson |
Operational/Managerial Control | Jul 1, 2022 | |
| Indirect Ownership Interest | Jan 1, 2021 | 37.5% | |
| Joshua E. Thompson |
Indirect Ownership Interest | Jan 1, 2021 | 25% |
| Donald Thompson |
5% Or Greater Indirect Ownership Interest |
Jun 27, 2016 | 50% |
| Managing Control - Governing Body |
Jun 27, 2016 | ||
| Indirect Ownership Interest | Jun 27, 2016 | 50% | |
| Brenda U. Thompson 2020 Irrevocable Trust Dated December 30, 2020 |
Indirect Ownership Interest | Jan 1, 2021 | 25% |
| Senior Living Commuities LLC |
Operational/Managerial Control | Jun 27, 2016 | |
| Direct Ownership Interest | Jun 27, 2016 | 100% | |
| Brenda U. Thompson 2020 Irrevocable Trust Dated December 30, 2020 |
Indirect Ownership Interest | Jan 1, 2021 | 25% |
| Maxwell Group, Inc. |
Operational/Managerial Control | Jan 23, 2025 | |
| Adp of the SNF | Jan 23, 2025 | ||
| Nhi-Reit of Evergreen LLC |
Adp of the SNF | Nov 8, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170111002442 | CT | Part a Provider - Skilled Nursing Facility | 9032490784 | Practice locations: North Branford, CT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
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
- Evergreen Woods
Other providers in North Branford, CT
- Donielle Didiano
- Sandra Lee Dizenzo
- Jamie Elena Dynderski
- Madeline Eldredge
- Evergreen Woods
- Candace Lynn Fazio
- Jessica Guivas
- Hannah Isacson D.C. LLC
- Kathleen Hassen Stack
- Shawna Holzer
All providers in North Branford, CT · Skilled Nursing Facility in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.