Provider Demographics
NPI:1285834176
Name:EVERGREEN LIVING HOME # 7
Entity Type:Organization
Organization Name:EVERGREEN LIVING HOME # 7
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-683-1711
Mailing Address - Street 1:233 COUNTRY TIME CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748
Mailing Address - Country:US
Mailing Address - Phone:828-683-2740
Mailing Address - Fax:
Practice Address - Street 1:233 COUNTRY TIME CIRCLE
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748
Practice Address - Country:US
Practice Address - Phone:828-683-2740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FCL-011-246310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility