Evergreen Quality Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

654400 Issued in WA

Legal business name

EVERGREEN QUALITY HOME

Doing business as

Adult Family Home

Practice address

304 NW 102ND St
Vancouver, WA 98685-5233

Phone

(360) 885-7933

Fax

(360) 573-7131

NPI assigned

May 17, 2011

Last updated

May 17, 2011By 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

Mrs. Marcia Roial-Craciun

Title

Provider

Phone

(360) 885-7933

Specialties & licenses 1

Addresses

Other names 1

• Adult Family Home Doing business as

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305590400000",
    "number": "1922391408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 NW 102ND ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986855233",
            "telephone_number": "360-885-7933",
            "fax_number": "360-573-7131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 NW 102ND ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986855233",
            "telephone_number": "360-885-7933",
            "fax_number": "360-573-7131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN QUALITY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-17",
        "last_updated": "2011-05-17",
        "status": "A",
        "authorized_official_last_name": "ROIAL-CRACIUN",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "360-885-7933",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "WA",
            "license": "654400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adult Family Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; 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.