Evergreen at Holladay, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2005-NCF-609 Issued in UT

Legal business name

EVERGREEN AT HOLLADAY, L.L.C.

Practice address

4600 South Highland Dr
Salt Lake City, UT 84117-5108

Phone

(801) 272-1892

Fax

(801) 274-2960

NPI assigned

May 5, 2006

Organization subpart

Yes

Parent organization

EVERGREEN UTAH HEALTHCARE, L.L.C.As reported in NPPES

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

Authorized official

Name

Ms. Anne M. Nipp

Title

Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Canyons Health and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262649600000",
    "number": "1548218050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE",
            "address_2": "SUITE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626729",
            "telephone_number": "360-892-6628",
            "fax_number": "360-882-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 SOUTH HIGHLAND DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841175108",
            "telephone_number": "801-272-1892",
            "fax_number": "801-274-2960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT HOLLADAY, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN UTAH HEALTHCARE, L.L.C.",
        "enumeration_date": "2006-05-05",
        "last_updated": "2010-01-05",
        "status": "A",
        "authorized_official_last_name": "NIPP",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-892-6628",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "UT",
            "license": "2005-NCF-609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Canyons Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wyatt Evans
• Kira Shayn Evensen
• Bret Everding
• Anna Ruth Everett, PA
• Paris Everett
• Evergreen Residential Care
• Everreach ABA Utah LLC
• Jacob Evertsen, BEHAVIOR TECHNICIAN
• Christopher M. Evola, MD
• Evolution Academy of Utah LLC

• Skilled Nursing Facility in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Skilled Nursing Facility in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; 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.