# EVERGREENS ASSISTED LIVING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861688087
- **Authorized official:** MARIAN GRENWAY (MANAGER)
- **Authorized official phone:** (301) 604-1761

## Contact information

- **Practice address:** 8795 MISSION RD, JESSUP, MD 20794-3943
- **Practice address phone:** (301) 604-1761
- **Practice address fax:** (301) 490-6256
- **Mailing address:** 8795 MISSION RD, JESSUP, MD 20794-3943
- **Mailing address phone:** (301) 604-1761
- **Mailing address fax:** (301) 490-6256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | 13AL160 | MD | Yes |

## Other

- **Enumeration date:** 09/20/2007
- **Last updated:** 09/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 783697000 | — | MD |