Organization
EVERGREEN NURSING HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOEL DUNNAM (CFO)
(251) 743-7137
Entity
Organization
Contact information
Practice address
100 SANDERS DR, EVERGREEN, AL 36401-3306
(251) 578-3783
(251) 578-3786
Mailing address
501 WHETSTONE ST, MONROEVILLE, AL 36460-2615
(251) 743-3609
(251) 575-5618
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
12509
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4750890S
—
AL
Enumeration date
03/22/2006
Last updated
03/06/2024
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