Evergreen Care Center Llc

NPI 1316939861 - Skilled Nursing Facility - 314000000X

NPI Details
NPI 1316939861
Enumeration Date 08/19/2005
Last Updated 05/27/2015
Entity Type Healthcare Provider
Active Over 11 years ago
Authorized Information
Name ROBERT M ROBERT
Position CFO
Phone (715) 526-3107
Fax (715) 524-8037
Practice Location
1250 S EVERGREEN ST
SHAWANO WI, 54166-3514, US
Phone (715) 526-3107
Fax (715) 524-8037
Business Location
1726 N BALLARD RD
APPLETON WI, 54911-2444, US
Phone (920) 991-9072
Fax (920) 749-4021
Toxanomy
Taxonomy Code 314000000X
License State Wisconsin
License Number 2896
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According to our database, Evergreen Care Center Llc NPI is 1316939861, taxonomy code is 314000000X and license number is 2896, license state is located at Wisconsin. Evergreen Care Center Llc physically located at 1250 S Evergreen St, Shawano WI, 54166-3514. NPI Number 1033115704 has the healthcare provider type.

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1316939861 NPI number is provided on an as is basis without warranty of any kind. 1316939861 is maintained by the National Plan & Provider Enumeration System. The contents of Evergreen Care Center Llc are for informational purposes only.