Evergreen Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2896 Issued in WI

Legal business name

EVERGREEN CARE CENTER LLC

Doing business as

D/B/a Atrium Post Acute Care of Shawano at Evergreen

Practice address

1250 S Evergreen St
Shawano, WI 54166-3514

Phone

(715) 526-3107

Fax

(715) 524-8037

NPI assigned

Aug 19, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert M Parkins

Title

Cfo

Phone

(920) 364-9754

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• D/B/A ATRIUM POST ACUTE CARE OF SHAWANO AT EVERGREEN Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432684800000",
    "number": "1316939861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 N BALLARD RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549112444",
            "telephone_number": "920-991-9072",
            "fax_number": "920-749-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 S EVERGREEN ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541663514",
            "telephone_number": "715-526-3107",
            "fax_number": "715-524-8037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2015-05-27",
        "status": "A",
        "authorized_official_last_name": "PARKINS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-364-9754"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20192000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "D/B/A ATRIUM POST ACUTE CARE OF SHAWANO AT EVERGREEN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sally Susan Egan, ATC, LAT, CSCS
• Kathleen Marie Elertson, NP
• Alisha Mary Erdmann, APNP, FNP-C
• David F. Erdmann, PT
• Kayla Erickson
• Alisha Frances Fahley, MD
• Family Foot and Ankle Clinic LLC
• Yu Chin Fang, MD
• David P Ferris, D.M.D.
• Jennifer Finch, D.O.

• Skilled Nursing Facility in Shawano, WI
• Providers in Shawano, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.