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NPI Code Detail

MEDICARE: EVERGREENS, INC.

MEDICARE: 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
1314000000XSkilled Nursing FacilityNH0236NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912966698
Entity Type Code : Organization
Provider Name (Legal Business Name) : 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 ARNOLD NEWMAN JR.
Credential :
Telephone Number : 336-886-4121
Provider Enumeration Date : 03/21/2006
Last Update Date : 08/22/2020

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1861696924 — MR. ROBERT JOHN KRETLOW
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