Evergreen at Lakeport, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

010000142 Issued in CA

Legal business name

EVERGREEN AT LAKEPORT, L.L.C.

Doing business as

Evergreen Lakekport Healthcare

Practice address

1291 Craig Ave
Lakeport, CA 95453-5704

Phone

(707) 263-6382

Fax

(707) 263-7213

NPI assigned

May 4, 2006

Last updated

Jan 30, 2017By 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

Brent Weil

Title

Ceo and Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Evergreen Lakekport 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": "1485734400000",
    "number": "1699723460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1291 CRAIG AVE",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535704",
            "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": "1291 CRAIG AVE",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535704",
            "telephone_number": "707-263-6382",
            "fax_number": "707-263-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT LAKEPORT, L.L.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES CALIFORNIA HEALTHCARE, LLC",
        "enumeration_date": "2006-05-04",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "WEIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO AND MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55222H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Lakekport Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Lakeport, CA
• Providers in Lakeport, 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 30, 2017; 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.