NPI 1003626862

Evergreen Opco LLC

Organisation Custodial Care Facility Eugene, OR

Practice location

Address: 3760 N Clarey St, Eugene, OR 97402-8744
Phone: (541) 607-9525
Mailing address: 609 Lakeview Blvd, Sandpoint, ID 83864-1120

Authorised official

Name: Trevor Wart
Title: Manager
Phone: (503) 706-6918

Registered specialties

Custodial Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 311Z00000X

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Registry record

NPI: 1003626862
Entity type: Organization
NPI issued: 13 Jan 2025
Record last updated: 13 Jan 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.