Provider Demographics
NPI:1356492649
Name:EVERGREEN LIVING INNOVATIONS, INC.
Entity Type:Organization
Organization Name:EVERGREEN LIVING INNOVATIONS, INC.
Other - Org Name:EVERGREEN COMMUNITY OF JOHNSON COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:K
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANGLAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-477-8227
Mailing Address - Street 1:11875 S SUNSET DR STE 100
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2794
Mailing Address - Country:US
Mailing Address - Phone:913-477-8227
Mailing Address - Fax:913-477-8001
Practice Address - Street 1:11875 S SUNSET DR STE 100
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-2794
Practice Address - Country:US
Practice Address - Phone:913-477-8227
Practice Address - Fax:913-477-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN046029314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100451870AMedicaid
KS100451870AMedicaid