Provider Demographics
NPI:1093577967
Name:EVERGREEN ASSISTED LIVING HOMES INC- RED ROBIN
Entity Type:Organization
Organization Name:EVERGREEN ASSISTED LIVING HOMES INC- RED ROBIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTS
Authorized Official - Prefix:
Authorized Official - First Name:EUNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-280-0210
Mailing Address - Street 1:7016 ANTRIM RD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6629 XEXES AVE S
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:651-280-0210
Practice Address - Fax:612-500-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility