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Organization

EVERGREEN PLACE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JORGE GUSTAVO GONZALEZ VILLARRUEL (OWNER)
(801) 921-0070
Entity
Organization

Contact information

Practice address
163 E 7800 S, MIDVALE, UT 84047-2612
(801) 921-0070
Mailing address
PO BOX 9193, MIDVALE, UT 84047-9193
(801) 921-0070

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Enumeration date
09/15/2017
Last updated
03/17/2018
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