NPI 1215456777

Evergreen Place LLC

Organisation Assisted Living Facility Midvale, UT

Practice location

Address: 163 E 7800 S, Midvale, UT 84047-2612
Phone: (801) 921-0070
Mailing address: PO Box 9193, Midvale, UT 84047-9193

Authorised official

Name: Jorge Gustavo Gonzalez Villarruel
Title: Owner
Phone: (801) 921-0070

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

Other Assisted Living Facility providers in Utah →

Registry record

NPI: 1215456777
Entity type: Organization
NPI issued: 15 Sep 2017
Record last updated: 17 Mar 2018

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.