EVERGREEN AT TRACY, L.L.C. (NPI# 1316995152) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316995152 |
| Entity Type | Organization |
| Organization Name | EVERGREEN AT TRACY, L.L.C. |
| Other Organization Name | NEW HOPE POST ACUTE CARE |
| Practice Address |
2586 Buthmann Ave Tracy CA 95376-2165 |
| Mailing Address |
4601 Ne 77th Ave Suite 300 Vancouver WA 98662-6736 |
| Practice Telephone | 2098322273 |
| Practice Fax Number | 2098320743 |
| Mailing Telephone | 3608926628 |
| Mailing Fax Number | 3608825793 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2017-01-30 |
| Authorized Official Name | BRENT WEIL (CEO AND MANAGER) |
| Authorized Official Telephone | 3608926628 |
| Is Organization Subpart | Y |
| Parent Organization Name | EMPRES CALIFORNIA HEALTHCARE, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 100000285 | CA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LTC55245I | 05 |
| Other Name | Type Code |
|---|---|
| New Hope Post Acute Care | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | EVERGREEN AT TRACY, L.L.C. | 2586 Buthmann Ave, Tracy, CA 95376-2165 |
| Street Address |
2586 BUTHMANN AVE |
| City | TRACY |
| State | CA |
| Zip Code | 95376-2165 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154989796 | Elizabeth Varghese | Physical Therapy Assistant | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2019-05-30 |
| 1245750728 | Lorlaine Besario Aguas | Occupational Therapist | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2017-06-26 |
| 1558785394 | Mikaela Kerkman | Occupational Therapist | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2014-02-14 |
| 1801158126 | Radha R Makker | Speech-Language Pathologist | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2012-06-12 |
| 1255611174 | Shana Kaye Furr | Occupational Therapist | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2011-08-23 |
| 1255625224 | Sheila Ann Lavagetto | Speech-Language Pathologist | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2011-06-07 |
| 1770898413 | Caren Beth Burgess | Occupational Therapy Assistant | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2010-08-18 |
| 1215177639 | Aileen Grace Perez | Physical Therapy Assistant | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2009-02-25 |
| 1346416286 | Agnes Balza | Specialist | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2008-04-30 |
| 1255517546 | Crystal Nerence Gomez Cunanan | Physical Therapist | 2586 Buthmann Ave, Tracy, CA 95376-2165 | 2008-01-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932757150 | James Burgess Angel | Technician, Other | 455 W. Eaton Ave., Tracy, CA 95376 | 2019-08-30 |
| 1477079655 | Cassandra Sierra | Specialist/Technologist | 632 W 11th St Ste 119, Tracy, CA 95376 | 2017-08-18 |
| 1922465491 | Jasmeer Kaur Uppal | Registered Nurse | 1411 N. Tracy Bl., Tracy, CA 95376 | 2016-01-28 |
| 1679957773 | Amy Forester | Physical Therapy Assistant | 1752 Schantz Way, Tracy, CA 95376 | 2015-07-17 |
| 1477966265 | Sarah Ojeda | Marriage & Family Therapist | 19 East 6th Street, Tracy, CA 95376 | 2014-06-09 |
| 1356761209 | Lucille Nowakowski | Registered Nurse | 95 West 11 Th St, Tracy, CA 95376 | 2014-04-18 |
| 1821417718 | Ricardo Echon | Nurse Practitioner | 644 W 12th Street, Tracy, CA 95376 | 2014-04-08 |
| 1508105354 | Sutter Central Valley Hospitals | Pharmacy | 1420 N. Tracy Blvd., Tracy, CA 95376 | 2013-02-13 |
| 1790034056 | Amy Powers | Counselor | 902 N Central Ave Ste 308, Tracy, CA 95376 | 2012-09-02 |
| 1982951554 | Gurpreet Singh Dhaliwal Md Inc. | Anesthesiology | 1530 Bessie Ave Ste 104, Tracy, CA 95376 | 2012-08-13 |
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| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659821296 | Virosa, LLC | Skilled Nursing Facility | 1051 Tennis Ln, Tracy, CA 95376-4417 | 2016-10-06 |
| 1346337896 | Faith Enterprises, Inc | Skilled Nursing Facility | 545 W Beverly Pl, Tracy, CA 95376-3012 | 2006-10-06 |
| 1730162918 | Tracy Nursing Home Inc | Skilled Nursing Facility | 487 2nd St, Tracy, MN 56175-1207 | 2005-11-22 |
| 1972865301 | Atmc LLC | Skilled Nursing Facility | 545 W Beverly Pl, Tracy, CA 95376-3012 | 2012-06-12 |
| 1245228725 | Tracy Healthcare Center, Inc | Skilled Nursing Facility | 250 5th St E, Tracy, MN 56175-1537 | 2005-10-10 |
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| 1780204024 | Neighbor Care Congregate Home, Inc. | Skilled Nursing Facility | 3249 Gerald Dr, Newbury Park, CA 91320-2948 | 2020-04-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.