Evergreen Terrace LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

0573 Issued in CO

Legal business name

EVERGREEN TERRACE LLC

Practice address

1625 Simms St
Lakewood, CO 80215-2611

Phone

(303) 238-8161

Fax

(303) 238-2714

NPI assigned

Apr 7, 2006

Organization subpart

No

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

Authorized official

Name

Michelle Zimbelman

Title

President

Phone

(816) 232-9573

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538122031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 SIMMS ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802152611",
            "telephone_number": "303-238-8161",
            "fax_number": "303-238-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 SIMMS ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802152611",
            "telephone_number": "303-238-8161",
            "fax_number": "303-238-2714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN TERRACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ZIMBELMAN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "816-232-9573"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CO",
            "license": "0573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05523532",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nursing Facility/Intermediate Care Facility in Lakewood, CO
• Providers in Lakewood, CO by specialty
• Nursing Facility/Intermediate Care Facility in Colorado

• 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.