NPIMap

Organization Active NPI

Evergreens Assisted Living

  • Respite Care
  • Jessup, MD
National Provider Identifier
1861688087
Registry record updated Sep 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Respite CareTaxonomy code 385H00000X
License
13AL160 Issued in MD
Legal business name
EVERGREENS ASSISTED LIVING
Practice address
8795 Mission Rd
Jessup, MD 20794-3943
Phone
(301) 604-1761
Fax
(301) 490-6256
NPI assigned
Sep 20, 2007
Last updated
Sep 20, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2007

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

Authorized official

Name
Marian Grenway
Title
Manager
Phone
(301) 604-1761

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Respite Care 385H00000X 13AL160 MD Primary

Addresses

Primary practice location

8795 Mission Rd
Jessup, MD 20794-3943

Mailing address

8795 Mission Rd
Jessup, MD 20794-3943
Phone (301) 604-1761

Other identifiers 1

IdentifierTypeStateIssuer
783697000MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Senior Day Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190246400000",
    "number": "1861688087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8795 MISSION RD",
            "city": "JESSUP",
            "state": "MD",
            "postal_code": "207943943",
            "telephone_number": "301-604-1761",
            "fax_number": "301-490-6256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8795 MISSION RD",
            "city": "JESSUP",
            "state": "MD",
            "postal_code": "207943943",
            "telephone_number": "301-604-1761",
            "fax_number": "301-490-6256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREENS ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2007-09-20",
        "status": "A",
        "authorized_official_last_name": "GRENWAY",
        "authorized_official_first_name": "MARIAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-604-1761"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "MD",
            "license": "13AL160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "783697000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jessup, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; 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.