Provider Demographics
NPI:1285898627
Name:ASSISTED LIVING AT EVERGREEN, INC.
Entity type:Organization
Organization Name:ASSISTED LIVING AT EVERGREEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:724-222-4227
Mailing Address - Street 1:336 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4326
Mailing Address - Country:US
Mailing Address - Phone:724-222-4227
Mailing Address - Fax:724-222-7946
Practice Address - Street 1:336 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4326
Practice Address - Country:US
Practice Address - Phone:724-222-4227
Practice Address - Fax:724-222-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA405780310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility