Organization
EVERGREEN TERRACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE ZIMBELMAN (PRESIDENT)
(816) 232-9573
Entity
Organization
Contact information
Practice address
1625 SIMMS ST, LAKEWOOD, CO 80215-2611
(303) 238-8161
(303) 238-2714
Mailing address
1625 SIMMS ST, LAKEWOOD, CO 80215-2611
(303) 238-8161
(303) 238-2714
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
0573
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05523532
—
CO
Enumeration date
04/07/2006
Last updated
08/22/2020
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