EVERGREEN LIVING #4 (NPI# 1609997519) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609997519 |
| Entity Type | Organization |
| Organization Name | EVERGREEN LIVING #4 |
| Practice Address |
230 Country Time Circle Leicester NC 28748 |
| Mailing Address |
Po Box 2077 Leicester NC 28748-2077 |
| Practice Telephone | 8287795588 |
| Mailing Telephone | 8287795588 |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | YOUNG S LEE (OWNER) |
| Authorized Official Telephone | 8287795588 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
FCL-011-217 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7805443 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255452017 | Evergreen Living #4 | Custodial Care Facility | 351 Family Ridge Road, Leicester, NC 28748 | 2007-04-02 |
| Street Address |
230 COUNTRY TIME CIRCLE |
| City | LEICESTER |
| State | NC |
| Zip Code | 28748 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366824195 | Smith Street Village Family Care Home, LLC | Custodial Care Facility | 230 Country Time Circle, Leicester, NC 28748-6213 | 2015-06-29 |
| 1427255264 | Evergreen Living Home #4 | Assisted Living Facility | 230 Country Time Circle, Leicester, NC 28748 | 2007-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659494300 | Evergreen Living #5 | Custodial Care Facility | 352 Family Ridge Road, Leicester, NC 28748 | 2007-04-09 |
| 1346361102 | Evergreen Living #1 | Custodial Care Facility | 101 Country Time Ln, Leicester, NC 28748 | 2007-04-02 |
| 1811018674 | Evergreen Living #6 | Custodial Care Facility | 353 Family Ridge Road, Leicester, NC 28748 | 2007-04-02 |
| 1053431957 | Evergreen Living #5 | Custodial Care Facility | 231 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1962522862 | Evergreen Living #6 | Custodial Care Facility | 232 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1639290497 | Evergreen Living #7 | Custodial Care Facility | 233 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1548381304 | Evergreen Living #8 | Custodial Care Facility | 234 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1457472219 | Evergreen Living #9 | Custodial Care Facility | 235 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1295856052 | Evergreen Living #10 | Custodial Care Facility | 236 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1861512972 | Evergreen Living #3 | Custodial Care Facility | 103 Country Time Ln, Leicester, NC 28748 | 2007-03-30 |
| Find all providers in zip 28748 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659494300 | Evergreen Living #5 | Custodial Care Facility | 352 Family Ridge Road, Leicester, NC 28748 | 2007-04-09 |
| 1346361102 | Evergreen Living #1 | Custodial Care Facility | 101 Country Time Ln, Leicester, NC 28748 | 2007-04-02 |
| 1811018674 | Evergreen Living #6 | Custodial Care Facility | 353 Family Ridge Road, Leicester, NC 28748 | 2007-04-02 |
| 1053431957 | Evergreen Living #5 | Custodial Care Facility | 231 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1962522862 | Evergreen Living #6 | Custodial Care Facility | 232 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1639290497 | Evergreen Living #7 | Custodial Care Facility | 233 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1548381304 | Evergreen Living #8 | Custodial Care Facility | 234 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1457472219 | Evergreen Living #9 | Custodial Care Facility | 235 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1295856052 | Evergreen Living #10 | Custodial Care Facility | 236 Country Time Circle, Leicester, NC 28748 | 2007-04-02 |
| 1861512972 | Evergreen Living #3 | Custodial Care Facility | 103 Country Time Ln, Leicester, NC 28748 | 2007-03-30 |
| Find all providers in LEICESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.