Provider Demographics
NPI:1700491560
Name:EVERGREEN GARDENS ASSISTED LIVING
Entity Type:Organization
Organization Name:EVERGREEN GARDENS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RINEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-455-2087
Mailing Address - Street 1:10120 STANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1738
Mailing Address - Country:US
Mailing Address - Phone:240-455-2087
Mailing Address - Fax:866-610-4342
Practice Address - Street 1:10120 STANSFIELD RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1738
Practice Address - Country:US
Practice Address - Phone:240-455-2087
Practice Address - Fax:866-610-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility