NPIMap

Organization Active NPI

Evergreen SNF Healthcare LLC

Doing business as Evergreen Post Acute

  • Skilled Nursing Facility
  • Portland, OR
National Provider Identifier
1629827167
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EVERGREEN SNF HEALTHCARE LLC
Doing business as
Evergreen Post Acute
Practice address
8643 NE Beech St
Portland, OR 97220-5012
Phone
(503) 256-2151
NPI assigned
May 16, 2024
Last updated
May 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

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

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(801) 447-9829

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

8643 NE Beech St
Portland, OR 97220-5012

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other names 1

  • Evergreen Post Acute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240829001753 OR Part A Provider - Skilled Nursing Facility 4789123175 Practice locations: Portland, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629827167. Details of each certification follow.

Skilled nursing facility certification: CCN 385258

Legal name
EVERGREEN SNF HEALTHCARE LLC
Doing business as
EVERGREEN POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1998
Last certification
Feb 18, 2025
Beds
55
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
May 10, 2024 in OR
Enrollment address
8643 NE Beech St
Portland, OR 97220-5012
Nursing home name
EVERGREEN POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Evergreen Post AcuteCCN 385258 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 1, 1998
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5552.3 residents per day on average
Chain
Pacs Group274 facilities in the chain
Penalties (3 years)
1Fines totaling $4,194

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D0890206Evergreen Post Acute8643 NE Beech St, Portland, OR 97220Certificate of waiverDec 31, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest May 10, 2024 35.2%
John T Mitchell Individual Operational/Managerial Control May 10, 2024
Tracy Brzycki Individual Operational/Managerial Control Sep 1, 2024
Frederick G Apt Individual Operational/Managerial Control May 10, 2024
David P Larson Individual Operational/Managerial Control Sep 1, 2024
Adp of the SNF May 30, 2025
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest May 10, 2024 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 10, 2024 100%
Providence Administrative Consulting Services Inc Organization, Farmington, UT Corporation, Consulting firm, For-profit Adp of the SNF Sep 1, 2024
Truist Bank Organization, Charlotte, NC Corporation, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Security Interest Sep 1, 2024 100%
Joshua O Jergensen Individual Operational/Managerial Control May 10, 2024
Portland 8643 Realty LLC Organization, New York, NY LLC, For-profit Adp of the SNF Sep 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest May 10, 2024 100%
Russell Carnagie Individual Operational/Managerial Control Sep 3, 2024
Adp of the SNF May 30, 2025
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest May 10, 2024 35.2%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 186

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 186

NPI Registry JSON

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

{
    "created_epoch": "1715817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1629827167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8643 NE BEECH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972205012",
            "telephone_number": "503-256-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SNF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-16",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "801-447-9829"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.