# EVERGREEN AT CASTRO VALLEY, L.L.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Evergreen Castro Valley
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740238575
- **Authorized official:** MR. ANDREW V. MARTINI (MANAGER)
- **Authorized official phone:** (360) 892-6628

## Contact information

- **Practice address:** 20259 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5307
- **Practice address phone:** (510) 351-3700
- **Practice address fax:** (510) 889-7955
- **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 | — | CA | Yes |

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZZRU5239J | — | CA |