Organization
EVERGREEN RETIREMENT RESIDENCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK MENLO (OWNER)
(818) 843-8268
Entity
Organization
Contact information
Practice address
225 N EVERGREEN ST, BURBANK, CA 91505
(818) 843-8268
Mailing address
225 N EVERGREEN ST, BURBANK, CA 91505-3925
(818) 843-8268
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
197609022
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191221567
DEPARTMENT OF SOCIAL SERVICES
CA
Enumeration date
06/18/2008
Last updated
05/14/2021
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