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NPI Code Detail

MEDICARE: THE EVERGREENS INC.

MEDICARE: THE EVERGREENS INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1311ZA0620XAdult Care Home FacilityNH0236NC
2314000000XSkilled Nursing FacilityNH0236NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100830OTHERNCBCBS PROVIDER NUMBER
223497OTHERNCPARTNERS PROVIDER NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
57801625OTHERNCMCAID PCS PROVIDER NO

General Provider Information

NPI Number : 1487668216
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE EVERGREENS INC.
Provider Business Mailing Address
First Line : 206 GREENSBORO RD
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-3456
Country : US
Telephone Number : 336-886-4121
Fax Number : 336-886-6285
Provider Business Practice Location Address
First Line : 206 GREENSBORO RD
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-3456
Country : US
Telephone Number : 336-886-4121
Fax Number : 336-886-6285
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. JAMES A NEWMAN JR.
Credential : LNHA
Telephone Number : 336-886-4121
Provider Enumeration Date : 07/28/2006
Last Update Date : 11/15/2007

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Practice Location Address:
206 GREENSBORO RD
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27260-3456
Practice Phone: 336-886-4121
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1962606038 — MR. RUBEN RIVERA
Practice Location Address:
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27260-3456
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Practice Fax: 336-882-2164
1861696924 — MR. ROBERT JOHN KRETLOW
Practice Location Address:
206 GREENSBORO RD
HIGH POINT, NC
27260-3456
Practice Phone: 336-882-2164
Practice Fax: 336-882-2164
1376747170 — MRS. DAWN ADAMS
Practice Location Address:
206 GREENSBORO RD
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27260-3456
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1053516146 — MR. ALAN CHARLES GORROD
Practice Location Address:
206 GREENSBORO RD
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