Provider Demographics
NPI:1912966698
Name:EVERGREENS, INC.
Entity Type:Organization
Organization Name: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:ARNOLD
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
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:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0236314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405178Medicaid
3405178Medicare ID - Type Unspecified