NPIMap

Organization Active NPI

Evergreen Group Home

  • Intellectual Disabilities Intermediate Care Facility
  • Urbana, MO
National Provider Identifier
1841452109
Registry record updated Jun 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
LC0556542 Issued in MO
Legal business name
EVERGREEN GROUP HOME
Practice address
27 Hopper TRL
Urbana, MO 65767-9234
Phone
(417) 722-4416
Fax
(417) 722-4417
NPI assigned
Jun 27, 2008
Last updated
Jun 27, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2008

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

Authorized official

Name
Mr. Gary D Boggs
Title
Director
Phone
(417) 722-4416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X LC0556542 MO Primary

Addresses

Primary practice location

27 Hopper TRL
Urbana, MO 65767-9234

Mailing address

27 Hopper TRL
Urbana, MO 65767-9234
Phone (417) 722-4416

Other names 1

  • Pineview Group Home Other name

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Group Home3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1841452109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 HOPPER TRL",
            "city": "URBANA",
            "state": "MO",
            "postal_code": "657679234",
            "telephone_number": "417-722-4416",
            "fax_number": "417-722-4417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 HOPPER TRL",
            "city": "URBANA",
            "state": "MO",
            "postal_code": "657679234",
            "telephone_number": "417-722-4416",
            "fax_number": "417-722-4417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-27",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "BOGGS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "417-722-4416",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MO",
            "license": "LC0556542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pineview Group Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Urbana, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; 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.