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General NPI Number Information
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NPI Number | 1467519538
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Entity Type | Organization
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Legal Business Name | EVERGREEN RESIDENCE
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 1305 KINGS CT
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City | RENO
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State | NV
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Zip | 89503-3521
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Country | US
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Telephone | 775-787-9520
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Fax | 775-747-7417
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Provider Business Mailing Address
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Address Line | 1305 KINGS CT
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City | RENO
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State | NV
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Zip | 89503-3521
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Country | US
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Telephone | 775-787-9520
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Fax | 775-747-7417
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. AMEI WOO
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Credential |
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Telephone | 775-787-9520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 3275AGC-6
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License Number State | NV
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