Evergreen Manor,Inc.
Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Sparta, WI
NPI 1386972024 · NPPES record last updated Nov 18, 2009
Key facts
- NPI
- 1386972024
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- License
- 0010512 (WI)
- Legal business name
- EVERGREEN MANOR,INC.
- Practice address
- 8429 Idyllview Ave
Sparta, WI 54656-3617 - Phone
- (608) 487-9067
- Fax
- (608) 487-9067
- NPI assigned
- Nov 18, 2009
- Organization subpart
- No
Authorized official
- Name
- Larenda L Rosin
- Title
- President
- Phone
- (608) 487-9067
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | 0010512 | WI | Yes |
Addresses
Primary practice location
8429 Idyllview Ave
Sparta, WI 54656-3617
Mailing address
8429 Idyllview Ave
Sparta, WI 54656-3617
Phone (608) 487-9067
Other providers in Sparta, WI
- Matthew J Englerth
- Theresa Ertl
- Kurt Charles Euller
- Evergreen Manor II
- Evergreen Manor III, Inc
- Amanda J Falkers
- Family & Childrens Center
- Austin W Feltner
- Ariel Dawn Ferdock
- Dawn Fitzmaurice
All providers in Sparta, WI · Mental Illness Community Based Residential Treatment Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.