# EVERGREEN AT GARDNERVILLE, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EMPRES NEVADA HEALTHCARE, LLC
- **Other names:** Gardnerville Health & Rehab Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083662514
- **Legal business name:** EMPRES NEVADA HEALTHCARE, LLC
- **Authorized official:** MICHAEL J. MILLER (CFO AND ASSISTANT MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 1573 MULLER PKWY, GARDNERVILLE, NV 89410-7918
- **Practice address phone:** (775) 782-6620
- **Practice address fax:** (775) 782-6945
- **Mailing address:** 4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6736
- **Mailing address phone:** (360) 892-6628
- **Mailing address fax:** (360) 882-5793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 314000000X | Skilled Nursing Facility | 3995SNF-5 | NV | Yes |

## Other

- **Enumeration date:** 05/05/2006
- **Last updated:** 02/01/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100503498 | — | NV |