# EVERGREEN AT MESA, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Evergreen Valley Health and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275581951
- **Authorized official:** MR. ANDREW V. MARTINI (MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 6458 E BROADWAY RD, MESA, AZ 85206-1727
- **Practice address phone:** (480) 832-5160
- **Practice address fax:** (480) 854-7046
- **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 | NCA-2627 | AZ | Yes |

## Other

- **Enumeration date:** 05/04/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 748767 | — | AZ |