Evergreen Congregate, LLC

Primary specialty

Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X

Legal business name

EVERGREEN CONGREGATE, LLC

Practice address

823 Towne St
Costa Mesa, CA 92627-3509

Phone

(949) 397-0658

NPI assigned

Feb 10, 2022

Last updated

Feb 10, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adam Cortland Green

Title

Owner

Phone

(949) 397-0658

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1558015248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27702 CROWN VALLEY PKWY",
            "city": "LADERA RANCH",
            "state": "CA",
            "postal_code": "926940608",
            "telephone_number": "949-397-0658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 TOWNE ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273509",
            "telephone_number": "949-397-0658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN CONGREGATE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-10",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "CORTLAND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-397-0658"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Evans, PH.D.
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• Patrick Everett, DPT
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• Ez Transportation
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• Charles Fagenholz, DC

• Physical Disabilities Residential Treatment Facility in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Physical Disabilities Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.