EVERGREEN TERRACE LLC (NPI# 1538122031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538122031 |
| Entity Type | Organization |
| Organization Name | EVERGREEN TERRACE LLC |
| Practice Address |
1625 Simms St Lakewood CO 80215-2611 |
| Practice Telephone | 3032388161 |
| Practice Fax Number | 3032382714 |
| Mailing Telephone | 3032388161 |
| Mailing Fax Number | 3032382714 |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MICHELLE ZIMBELMAN (PRESIDENT) |
| Authorized Official Telephone | 8162329573 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 0573 | CO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 05523532 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | EVERGREEN TERRACE LLC | 543 Bedford Avenue, Suite 221, Brooklyn, Ny 11211 |
| Colorado Business Entities | Evergreen Terrace LLC | 15655 East Prentice Lane, Centennial, CO 80015-4262 |
| Street Address |
1625 SIMMS ST |
| City | LAKEWOOD |
| State | CO |
| Zip Code | 80215-2611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104235407 | B Simone Caruthers | Psychologist | 1625 Simms St, Lakewood, CO 80215-2611 | 2014-08-12 |
| 1073957908 | Lakewood Villa Operations, LLC | Clinic/Center | 1625 Simms St, Lakewood, CO 80215-2611 | 2013-04-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679199566 | Alta Vista Center for Autism | Speech-Language Pathologist | 2001 Hoyt Street, Lakewood, CO 80215 | 2020-06-17 |
| 1871154419 | Ahc of Lakewood, LLC | Skilled Nursing Facility | 1565 Pierson Street, Lakewood, CO 80215 | 2019-06-25 |
| 1235646209 | Ashley Wiersma | Social Worker | 9485 W. Colfax Ave, Lakewood, CO 80215 | 2017-12-29 |
| 1619480563 | Amy Christine Ladebue | Counselor | 2596 Moore St, Lakewood, CO 80215 | 2017-11-14 |
| 1407374408 | Carly Young | Physician Assistant | 11171 W 17th Ave, Apt 303, Lakewood, CO 80215 | 2017-08-30 |
| 1356876700 | Our Family Care Home Assisted Living LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1169 Johnson Street, Lakewood, CO 80215 | 2017-04-24 |
| 1194263251 | Daniela Rosenberg | Student in an Organized Health Care Education/Training Program | 9845 W. Colfax Avenue, Jefferson Center for Mental Health, Lakewood, CO 80215 | 2017-02-08 |
| 1033596747 | Autumn Grove | Physical Therapist | 11185 W. 6th Avenue, Lakewood, CO 80215 | 2015-05-01 |
| 1649690264 | Neil George Norton | Dentist | 9990 W. 26th Ave, Lakewood, CO 80215 | 2014-04-22 |
| 1366873820 | Whitney Anne Post | Counselor | 1439 Estes St., Lakewood, CO 80215 | 2013-12-10 |
| Find all providers in zip 80215 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740699883 | Melissa | Nursing Facility/Intermediate Care Facility | 13501 Lakewood Heights Blvd Apt 5, Lakewood, OH 44107-6157 | 2014-08-02 |
| 1487656773 | Crestmont Nursing Home North Corp. | Nursing Facility/Intermediate Care Facility | 13330 Detroit Ave, Lakewood, OH 44107-2850 | 2005-06-01 |
| 1568887479 | Azura of Lakewood | Nursing Facility/Intermediate Care Facility | 7395 W Eastman Pl, Lakewood, CO 80227-5006 | 2014-02-28 |
| 1063781250 | Geriatric and Family Medicine | Nursing Facility/Intermediate Care Facility | 8015 W Alameda Ave, 210, Lakewood, CO 80226-3041 | 2011-12-19 |
| 1285807602 | Prime Rehabilitation Services, Inc | Nursing Facility/Intermediate Care Facility | 20 13th St, Lakewood, NJ 08701-1979 | 2008-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871816751 | Kaiser | Nursing Facility/Intermediate Care Facility | 2839 S Memphis St, Aurora, CO 80013-1858 | 2010-03-08 |
| 1972740280 | Bianca's Touch | Nursing Facility/Intermediate Care Facility | 17145 E Chenango Ave Unit F, Aurora, CO 80015-1896 | 2009-01-09 |
| 1881848711 | Orcr, Inc | Nursing Facility/Intermediate Care Facility | 1500 Hooker St, Denver, CO 80204-1933 | 2008-11-05 |
| 1871705756 | Cheyenne County Hospital District IIi | Nursing Facility/Intermediate Care Facility | 561 W 1st N, Cheyenne Wells, CO 80810 | 2007-05-04 |
| 1073647459 | Segwick County Heatlh Center | Nursing Facility/Intermediate Care Facility | 901 Cedar St, Julesburg, CO 80737-1120 | 2007-03-15 |
| 1164502761 | Northwest Colorado Visting Nurse Association | Nursing Facility/Intermediate Care Facility | 483 Yampa Ave, Craig, CO 81625-2019 | 2006-10-17 |
| 1780772269 | Walsh Hospital District | Nursing Facility/Intermediate Care Facility | 150 N Nevada St, Walsh, CO 81090 | 2006-10-10 |
| 1184683278 | Conejos County Hospital Corporation Long Term Care Unit | Nursing Facility/Intermediate Care Facility | 19021 State Hwy 885, La Jara, CO 81140 | 2006-03-20 |
| 1356324578 | Little Sisters of The Poor Mullen Home | Nursing Facility/Intermediate Care Facility | 3629 W 29th Ave, Denver, CO 80211-3601 | 2005-11-22 |
| 1053302695 | Southeast Colorado Hospital District | Nursing Facility/Intermediate Care Facility | 373 East 10th Avenue, Springfield, CO 81073-1622 | 2005-11-02 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EVERGREEN TERRACE LLC.
| 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.