| Organization Name: | EVERGREENS ASSISTED LIVING |
| NPI Number: | 1861688087 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIAN GRENWAY (MANAGER) |
| Mailing Address: | 8795 Mission Rd Jessup |
| State: | MD US |
| Postal Code: | 207943943 |
| Phone Number: | 3016041761 |
| Fax Number: | 3014906256 |
| NPI Enumeration Date: | 09/20/2007 |
| NPI Last Update Date: | 09/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 13AL160 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |