Provider Demographics
NPI:1487668216
Name:THE EVERGREENS INC.
Entity Type:Organization
Organization Name:THE EVERGREENS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:LNHA
Authorized Official - Phone:336-886-4121
Mailing Address - Street 1:206 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-3456
Mailing Address - Country:US
Mailing Address - Phone:336-886-4121
Mailing Address - Fax:336-886-6285
Practice Address - Street 1:206 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-3456
Practice Address - Country:US
Practice Address - Phone:336-886-4121
Practice Address - Fax:336-886-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0236311ZA0620X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00830OtherBCBS PROVIDER NUMBER
NC23497OtherPARTNERS PROVIDER NUMBER
NC3405178Medicaid
NC3406161Medicaid
NC7801625OtherMCAID PCS PROVIDER NO
NC23497OtherPARTNERS PROVIDER NUMBER
NC345178Medicare Oscar/Certification