Evergreen Health Care Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

133802 Issued in PA

Legal business name

EVERGREEN HEALTH CARE CENTER, LLC

Practice address

701 Clay Ave
Scranton, PA 18510-1759

Phone

(570) 344-2800

Fax

(570) 344-1977

NPI assigned

Jun 23, 2010

Last updated

Sep 7, 2010By 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. Michael P Kelly

Title

President

Phone

(570) 969-2188

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283817600000",
    "number": "1811208077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 MOLTKE AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185052886",
            "telephone_number": "570-969-2188",
            "fax_number": "570-969-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CLAY AVE",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185101759",
            "telephone_number": "570-344-2800",
            "fax_number": "570-344-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HEALTH CARE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-23",
        "last_updated": "2010-09-07",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-969-2188",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "133802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024773960001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaelyn Evans, PTA
• Keelin Mary Evans, CRNP
• Lindsey Morgan Evans, PA-C
• Nancy Marie Evans, RPH
• Jillian M Evarts, PA-C
• Shannon Elizabeth Exeter, PHARMD
• Eye Care Specialists, P.C.
• Gloria Eynon, PTA
• Michael Eynon, PT
• Brianne Ezman

• Skilled Nursing Facility in Scranton, PA
• Providers in Scranton, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; 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.