Evergreen at Castro Valley, L.L.C.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EVERGREEN AT CASTRO VALLEY, L.L.C.

Doing business as

Evergreen Castro Valley

Practice address

20259 Lake Chabot Rd
Castro Valley, CA 94546-5307

Phone

(510) 351-3700

Fax

(510) 889-7955

NPI assigned

May 4, 2006

Last updated

Aug 22, 2020By 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

Mr. Andrew V. Martini

Title

Manager

Phone

(360) 892-6628

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Evergreen Castro Valley 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": "1598054400000",
    "number": "1740238575",
    "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": "20259 LAKE CHABOT RD",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465307",
            "telephone_number": "510-351-3700",
            "fax_number": "510-889-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN AT CASTRO VALLEY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINI",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "V.",
        "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": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZRU5239J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Castro Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rebecca Lee Fallen

• Skilled Nursing Facility in Castro Valley, CA
• Providers in Castro Valley, 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 Aug 22, 2020; 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.