Organization
EVERGREEN PLACE LLC
Active
Parent organization
82230602
Organization subpart
Yes
Provider details
NPI number
Legal business name
82230602
Authorized official
JORGE GUSTAVO GONZALEZ VILLARRUEL (OWNER)
(801) 921-0070
Entity
Organization
Contact information
Practice address
3481 W 3100 S, WEST VALLEY CITY, UT 84119-2559
(801) 921-0070
Mailing address
PO BOX 9193, MIDVALE, UT 84047-9193
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
10/03/2017
Last updated
10/03/2017
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