Evergreen Manor Iii, Inc

NPI 1033447776 - Community Based Residential Treatment Facility, Mental Illness - 320800000X

NPI Details
NPI 1033447776
Enumeration Date 11/18/2009
Last Updated 11/18/2009
Entity Type Healthcare Provider
Active Over 7 years ago
Authorized Information
Name LARENDA L LARENDA
Position PRESIDENT
Phone (608) 487-9067
Fax (608) 487-9067
Practice Location
8429 IDYLLVIEW AVE
SPARTA WI, 54656-3617, US
Phone (608) 487-9067
Fax (608) 487-9067
Business Location
8429 IDYLLVIEW AVE
SPARTA WI, 54656-3617, US
Phone (608) 487-9067
Fax (608) 487-9067
Toxanomy
Taxonomy Code 320800000X
License State Wisconsin
License Number 0011807
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According to our database, Evergreen Manor Iii, Inc NPI is 1033447776, taxonomy code is 320800000X and license number is 0011807, license state is located at Wisconsin. Evergreen Manor Iii, Inc physically located at 8429 Idyllview Ave, Sparta WI, 54656-3617. NPI Number 1033115704 has the healthcare provider type.

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1033447776 NPI number is provided on an as is basis without warranty of any kind. 1033447776 is maintained by the National Plan & Provider Enumeration System. The contents of Evergreen Manor Iii, Inc are for informational purposes only.