Organization
EVERGREEN AT MESA, L.L.C.
Active
Other names
Evergreen Valley Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW V. MARTINI (MANAGER)
(360) 892-6628
Entity
Organization
Contact information
Practice address
6458 E BROADWAY RD, MESA, AZ 85206-1727
(480) 832-5160
(480) 854-7046
Mailing address
4601 NE 77TH AVE, SUITE 300, VANCOUVER, WA 98662-6729
(360) 892-6628
(360) 882-5793
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCA-2627
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
748767
—
AZ
Enumeration date
05/04/2006
Last updated
08/22/2020
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