Organization
EVERGREEN AT LAKEPORT, L.L.C.
Active
Parent organization
EMPRES CALIFORNIA HEALTHCARE, LLC
Other names
Evergreen Lakekport Healthcare
Organization subpart
Yes
Provider details
NPI number
Legal business name
EMPRES CALIFORNIA HEALTHCARE, LLC
Authorized official
BRENT WEIL (CEO AND MANAGER)
(360) 892-6628
Entity
Organization
Contact information
Practice address
1291 CRAIG AVE, LAKEPORT, CA 95453-5704
(707) 263-6382
(707) 263-7213
Mailing address
1291 CRAIG AVE, LAKEPORT, CA 95453-5704
(360) 892-6628
(360) 882-5793
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
010000142
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC55222H
—
CA
Enumeration date
05/04/2006
Last updated
01/30/2017
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