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EVERGREEN SUPPORTED LIVING
NPI 1124767587
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Bellingham, WA

Active since June 02, 2022CLIA 50D0695155 · Waiver
305 FLORA ST, BELLINGHAM, WA 98225(360) 671-5898(360) 922-0648 Get Directions Write a Review

NPPES record last updated: June 2, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Evergreen Supported Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN SUPPORTED LIVING (NPI 1124767587) is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Bellingham, Washington and active in the NPI registry since June 2022. The organization holds a CLIA Waiver certificate valid through April 4, 2028, maintains a secondary practice location in Bellingham, and lists Zay Aidan Smith Mcshane, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1124767587
Entity TypeOrganization
Primary Taxonomy320900000X
Legal Business NameEVERGREEN SUPPORTED LIVING
Location Address305 FLORA STBellingham, WA 98225-4430
Mailing Address305 Flora StBellingham, WA 98225-4430 · (360) 671-5898 · Fax (360) 922-0648
Phone(360) 671-5898
Fax(360) 922-0648
Organization SubpartNo
Authorized OfficialZay Aidan Smith McshaneExecutive Director · (360) 671-5898
Enumeration DateJune 2, 2022
NPPES CertifiedJune 2, 2022
✔ NPI 1124767587 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities
Taxonomy Code320900000X
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
Also ListedBehavior TechnicianTaxonomy 106S00000X
Also ListedCase ManagementTaxonomy 251B00000X
Also ListedDay Training, Developmentally Disabled ServicesTaxonomy 251C00000X
Also ListedIn Home Supportive CareTaxonomy 253Z00000X
Also ListedHome Health AideTaxonomy 374U00000X
305 FLORA ST, Bellingham, WA 98225
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Secondary Practice Location 1

Location 11970 Fraser St Apt 106Bellingham, WA 98229-3794 · Phone (360) 671-5898

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D0695155

Evergreen Supported Living · Bellingham, WA
Active · expires Apr 4, 2028
CLIA Number50D0695155
Laboratory TypeOther
Certificate Effective DateSeptember 1, 1992
Certificate Expiration DateApril 4, 2028
Laboratory DirectorZay Mcshane
Laboratory Phone(360) 671-5898
Laboratory LocationEvergreen Supported Living305 Flora St, Bellingham, WA 98225
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ZAY AIDAN SMITH MCSHANE
Day Training/Habilitation Specialist
305 FLORA ST
BELLINGHAM, WA 98225
Whatcom County (360) 671-5898

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Supported Living's NPI number?

The NPI number for Evergreen Supported Living is 1124767587. It was assigned to this organization in the NPPES registry on June 2, 2022.

Where is Evergreen Supported Living located?

Evergreen Supported Living is located at 305 Flora St, Bellingham, WA 98225. The listed phone number is (360) 671-5898.

What is Evergreen Supported Living's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Does Evergreen Supported Living hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D0695155) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Evergreen Supported Living was last updated on June 2, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.