Organization
EVERGREEN RESIDENTIAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MELVIN DARCY FORSMAN (OWNER)
(801) 272-2601
Entity
Organization
Contact information
Practice address
2374 EVERGREEN AVE, SALT LAKE CITY, UT 84109-3006
(801) 272-2601
(801) 278-3697
Mailing address
2374 EVERGREEN AVE, SALT LAKE CITY, UT 84109-3006
(801) 272-2601
(801) 278-3697
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
2919
UT
Other
Enumeration date
12/27/2006
Last updated
08/22/2020
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