Evergreen Senior Care Service LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

EVERGREEN SENIOR CARE SERVICE LLC

Practice address

9701 S 200TH St
Kent, WA 98031-1442

Phone

(253) 856-2790

Fax

(253) 981-3156

NPI assigned

Mar 1, 2025

Organization subpart

No

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

Authorized official

Name

Taweke S GebreselassieNPI 1154095461

Title

Owner

Phone

(253) 856-2790

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taweke S Gebreselassie

  • Registered Nurse
  • Auburn, WA
  • NPI 1154095461
  NPD Authorized official

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

{
    "created_epoch": "1740787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740787200000",
    "number": "1992502595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9701 S 200TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980311442",
            "telephone_number": "253-856-2790",
            "fax_number": "253-981-3156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 S 200TH ST",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980311442",
            "telephone_number": "253-856-2790",
            "fax_number": "253-981-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN SENIOR CARE SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-01",
        "last_updated": "2025-03-01",
        "certification_date": "2025-03-01",
        "status": "A",
        "authorized_official_last_name": "GEBRESELASSIE",
        "authorized_official_first_name": "TAWEKE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-856-2790"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Kent, WA
• Providers in Kent, 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 Mar 1, 2025; 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.