# EVERGREEN AT PETALUMA, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EMPRES CALIFORNIA HEALTHCARE, L.L.C.
- **Other names:** EmpRes Post Acute Rehabilitation
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104874940
- **Legal business name:** EMPRES CALIFORNIA HEALTHCARE, L.L.C.
- **Authorized official:** BRENT WEIL (CEO AND MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 300 DOUGLAS ST, PETALUMA, CA 94952-2503
- **Practice address phone:** (707) 763-6887
- **Practice address fax:** (707) 763-0314
- **Mailing address:** 4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6729
- **Mailing address phone:** (360) 892-6628
- **Mailing address fax:** (360) 882-5793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 010000018 | CA | Yes |

## Other

- **Enumeration date:** 05/04/2006
- **Last updated:** 01/30/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZRO6120J | — | CA |