Evergreen Terrace Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL540279286 Issued in MI

Legal business name

EVERGREEN TERRACE ASSISTED LIVING

Practice address

801 Fuller Ave
Big Rapids, MI 49307-2106

Phone

(231) 527-1050

NPI assigned

Nov 17, 2009

Last updated

Nov 17, 2009By 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

Wendi Michalski

Title

Administrator

Phone

(231) 527-1050

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258416000000",
    "number": "1750618443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3196 KRAFT AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122078",
            "telephone_number": "616-464-1564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 FULLER AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072106",
            "telephone_number": "231-527-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN TERRACE ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "last_updated": "2009-11-17",
        "status": "A",
        "authorized_official_last_name": "MICHALSKI",
        "authorized_official_first_name": "WENDI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-527-1050"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MI",
            "license": "AL540279286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "23D1102189",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noah Emerson, MA, SLC, NCC
• John Campbell Erwin, LLMSW
• Amy Frances Evans, LMSW
• Evergreen Physical Therapy Limited Partnership
• Evergreen Terrace Assisted Living (Evergreen Terrace Assisted Living - Laboratory)
• Eyeglass Acquisitions, Inc. (Smeelink Optical)
• Jazlyn K Ezell
• Amber Fate, CPRC
• Melanie May Fawbush
• Ivy L Fedewa

• Assisted Living Facility in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Assisted Living Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; 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.