EVERGREEN CONGREGATE, LLC
NPI 1558015248
Residential Treatment Facility, Physical Disabilities in Costa Mesa, CA
About Evergreen Congregate, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EVERGREEN CONGREGATE, LLC (NPI 1558015248) is a healthcare organization registered as a residential treatment facility, physical disabilities in Costa Mesa, California and active in the NPI registry since February 2022. The organization holds a CLIA Waiver certificate valid through July 7, 2027 and lists Adam Cortland Green, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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 05D2326693
Evergreen Congregate · Costa Mesa, CAFrequently 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 Congregate, LLC's NPI number?
The NPI number for Evergreen Congregate, LLC is 1558015248. It was assigned to this organization in the NPPES registry on February 10, 2022.
Where is Evergreen Congregate, LLC located?
Evergreen Congregate, LLC is located at 823 Towne St, Costa Mesa, CA 92627. The listed phone number is (949) 397-0658.
What is Evergreen Congregate, LLC's specialty?
The primary specialty registered for this NPI is Residential Treatment Facility, Physical Disabilities with taxonomy code 320700000X.
Does Evergreen Congregate, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2326693) is associated with this NPI, valid through July 7, 2027. 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 Congregate, LLC was last updated on February 10, 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.
# Evergreen Congregate, Llc · NPI 1558015248
Residential Treatment Facility, Physical Disabilities organization in Costa Mesa, California. Organization record, active in the CMS NPPES registry since February 10, 2022.
## Identity
- **NPI:** 1558015248 (Entity type: Organization)
- **Enumerated:** February 10, 2022
- **Primary specialty:** Residential Treatment Facility, Physical Disabilities · taxonomy 320700000X
- **Organization subpart:** No
- **Authorized official:** Adam Green, OWNER
## Practice location
- **Address:** 823 TOWNE ST, Costa Mesa, CA 92627-3509
- **Phone:** (949) 397-0658
## Record status
- **NPPES last updated:** February 10, 2022
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1558015248) · Data from the CMS NPPES public registry.