Evergreen at Arvin L L C

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

120000167 Issued in CA

Legal business name

EVERGREEN AT ARVIN L L C

Doing business as

Evergreen Arvin Healthcare

Practice address

323 Campus Dr
Arvin, CA 93203-1047

Phone

(661) 854-4475

Fax

(661) 854-4950

NPI assigned

May 4, 2006

Last updated

Jan 9, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

EMPRES CALIFORNIA HEALTHCARE, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Dale L. Patterson

Title

Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Evergreen Arvin Healthcare Doing business as

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357689600000",
    "number": "1568410769",
    "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": "323 CAMPUS DR",
            "city": "ARVIN",
            "state": "CA",
            "postal_code": "932031047",
            "telephone_number": "661-854-4475",
            "fax_number": "661-854-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT ARVIN L L C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES CALIFORNIA HEALTHCARE, LLC",
        "enumeration_date": "2006-05-04",
        "last_updated": "2013-01-09",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "360-892-6628",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "120000167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55170I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Arvin Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Thomas Dipalma
• Jacinda Renee Eldridge, RDH
• Lakeisha Shatara Falls, APRN, FNP-C
• Michael Bruce Farber, M.D.
• Ela Fiesta
• Jazmin Firo
• Elvira Flores, RDH

• Skilled Nursing Facility in Arvin, CA
• Providers in Arvin, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2013; 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.