1. Home
  2. Directory
  3. North Dakota
  4. Ellendale
  5. Assisted Living Facility
  6. NPI Profile

EVERGREEN PLACE
NPI 1538287263
Assisted Living Facility in Ellendale, ND

Active since March 27, 2007CLIA 35D1051548 · Waiver
241 MAIN STREET, ELLENDALE, ND 58436(701) 349-4550(701) 349-4656 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Evergreen Place NPPES

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

EVERGREEN PLACE (NPI 1538287263) is a healthcare organization registered as an assisted living facility in Ellendale, North Dakota and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through March 5, 2028 and lists Tony Hanson, Administrator-ceo, as its authorized official.

NPPES Registry Identity

NPI1538287263
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEVERGREEN PLACE
Location Address241 MAIN STREETEllendale, ND 58436
Mailing Address201 8th St NEllendale, ND 58436-7341 · (701) 349-4550 · Fax (701) 349-4656
Phone(701) 349-4550
Fax(701) 349-4656
Organization SubpartNo
Authorized OfficialTony HansonAdministrator-ceo · (701) 349-3312
Enumeration DateMarch 27, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1538287263 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in ND · 30729
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
241 MAIN STREET, Ellendale, ND 58436
Open in Google Maps ↗

Other Identifiers 1

Medicaid30729ND

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 35D1051548

Evergreen Place · Ellendale, ND
Active · expires Mar 5, 2028
CLIA Number35D1051548
Laboratory TypeOther
Certificate Effective DateMarch 6, 2026
Certificate Expiration DateMarch 5, 2028
Laboratory DirectorPaula Witt
Laboratory Phone(701) 349-4550
Laboratory LocationEvergreen PlaceAttn Michele Thorpe 241 Main St, Ellendale, ND 58436
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Place's NPI number?

The NPI number for Evergreen Place is 1538287263. It was assigned to this organization in the NPPES registry on March 27, 2007.

Where is Evergreen Place located?

Evergreen Place is located at 241 Main Street, Ellendale, ND 58436. The listed phone number is (701) 349-4550.

What is Evergreen Place's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Evergreen Place hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 35D1051548) is associated with this NPI, valid through March 5, 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 Place was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.