Evergreen Retirement Residence

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

197609022 Issued in CA

Legal business name

EVERGREEN RETIREMENT RESIDENCE

Practice address

225 N Evergreen St
Burbank, CA 91505

Phone

(818) 843-8268

NPI assigned

Jun 18, 2008

Organization subpart

No

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

Authorized official

Name

Frank Menlo

Title

Owner

Phone

(818) 843-8268

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620950400000",
    "number": "1861653370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N EVERGREEN ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915053925",
            "telephone_number": "818-843-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N EVERGREEN ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "91505",
            "telephone_number": "818-843-8268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RETIREMENT RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-18",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A",
        "authorized_official_last_name": "MENLO",
        "authorized_official_first_name": "FRANK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-843-8268"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": "197609022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF SOCIAL SERVICES",
            "identifier": "191221567",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Burbank, CA
• Providers in Burbank, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2021; 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.