Evergreen Home Of Berlin, Inc.

NPI 1063742526 - Community Based Residential Treatment Facility, Mental Illness - 320800000X

NPI Details
NPI 1063742526
Enumeration Date 01/06/2010
Last Updated 01/06/2010
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name LARENDA L LARENDA
Position PRESIDENT
Phone (920) 361-3231
Fax (920) 361-3231
Practice Location
508 E MARQUETTE ST
BERLIN WI, 54923-9404, US
Phone (920) 361-3231
Fax (920) 361-3231
Business Location
8429 IDYLLVIEW AVE
SPARTA WI, 54656-3617, US
Phone (608) 487-9067
Fax (608) 487-9067
Toxanomy
Taxonomy Code 320800000X
License State
License Number
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According to our database, Evergreen Home Of Berlin, Inc. NPI is 1063742526, taxonomy code is 320800000X Evergreen Home Of Berlin, Inc. physically located at 508 E Marquette St, Berlin WI, 54923-9404. NPI Number 1033115704 has the healthcare provider type.

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1063742526 NPI number is provided on an as is basis without warranty of any kind. 1063742526 is maintained by the National Plan & Provider Enumeration System. The contents of Evergreen Home Of Berlin, Inc. are for informational purposes only.