EVERGREEN PLACE LLC NPI 1487164505

NPI Information

NPI: 1487164505
Provider Name: EVERGREEN PLACE LLC
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Address:
3481 W 3100 S
WEST VALLEY CITY, UT
ZIP 84119
Phone: (801) 921-0070
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EVERGREEN PLACE LLC is an assisted living facility in West Valley City, UT. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. EVERGREEN PLACE LLC NPI is 1487164505. The provider is registered as an organization entity type.

The provider's business location address is:

3481 W 3100 S
WEST VALLEY CITY, UT
ZIP 84119-559
Phone: (801) 921-0070

The provider's authorized official is Jorge Gustavo Gonzalez Villarruel .
The authorized official title is Owner and has the following contact phone number (801) 921-0070.

The enumeration date for this NPI number is 10/3/2017 and was last updated on 10/3/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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