Evergreen Pines Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

14846 Issued in WI

Legal business name

EVERGREEN PINES INC

Practice address

343 E Cumberland St
Berlin, WI 54923-1206

Phone

(920) 290-3305

NPI assigned

Nov 19, 2013

Last updated

Nov 19, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Keri M Haywood

Title

President

Phone

(920) 229-3664

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1384819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1851721344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 506",
            "city": "SPARTA",
            "state": "WI",
            "postal_code": "546560506",
            "telephone_number": "920-229-3664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 E CUMBERLAND ST",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231206",
            "telephone_number": "920-290-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PINES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-19",
        "last_updated": "2013-11-19",
        "status": "A",
        "authorized_official_last_name": "HAYWOOD",
        "authorized_official_first_name": "KERI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-229-3664"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": "14846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin K Eferem, M.D.
• Jill Margaret Egbert, PTA
• Gary A. Eggert, D.D.S.
• Emily T Engelke, CD
• Evergreen Home of Berlin, Inc.
• Jason Lee Fairweather, LPC, SACIT, CSIT
• Field Pharmacy LLC
• Benjamin Field, DPH
• Andrea Kae Fitzgerald, PTA
• Jason Flynn, PHARMD

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Berlin, WI
• Providers in Berlin, WI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2013; 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.