# EVERGREEN AT LAKEPORT, L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EMPRES CALIFORNIA HEALTHCARE, LLC
- **Other names:** Evergreen Lakekport Healthcare
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1699723460
- **Legal business name:** EMPRES CALIFORNIA HEALTHCARE, LLC
- **Authorized official:** BRENT WEIL (CEO AND MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 1291 CRAIG AVE, LAKEPORT, CA 95453-5704
- **Practice address phone:** (707) 263-6382
- **Practice address fax:** (707) 263-7213
- **Mailing address:** 1291 CRAIG AVE, LAKEPORT, CA 95453-5704
- **Mailing address phone:** (360) 892-6628
- **Mailing address fax:** (360) 882-5793

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 010000142 | CA | Yes |

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LTC55222H | — | CA |