MEDICARE: EVERGREEN LIVING LLC

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
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1831057058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERGREEN LIVING LLC

Provider Business Mailing Address
First Line	:	7481 W ROME BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3527
Country	:	US
Telephone Number	:	480-239-0213
Fax Number	:

Provider Business Practice Location Address
First Line	:	7481 W ROME BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3527
Country	:	US
Telephone Number	:	480-239-0213
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHARON SAN GASPAR
Credential	:
Telephone Number	:	480-239-0213

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “EVERGREEN LIVING LLC ” Practice Location

Language	Start Address	Practice Location

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