Evergreen Place LLC
NPI #1487164505 in West Valley City, Utah
Provider Information
- NPI Number
- 1487164505
- Entity Type
- Organization
- Organization Name
- Evergreen Place LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- 82230602
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Oct 3, 2017
- Last Updated
- Oct 3, 2017
Practice Location
- Address
- 3481 W 3100 S
- City
- West Valley City
- State
- Utah
- ZIP Code
- 84119-2559
- Phone
- (801) 921-0070
Authorized Official
- Name
- JORGE GUSTAVO GONZALEZ VILLARRUEL
- Title
- OWNER
- Phone
- (801) 921-0070
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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