Evergreen Home of Berlin, Inc.

NPI #1063742526 in Berlin, Wisconsin

Provider Information

NPI Number: 1063742526
Entity Type: Organization
Organization Name: Evergreen Home of Berlin, Inc.
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Jan 6, 2010
Last Updated: Jan 6, 2010

Practice Location

Address: 508 E MARQUETTE ST
City: Berlin
State: Wisconsin
ZIP Code: 54923-9404
Phone: (920) 361-3231

Authorized Official

Name: LARENDA L ROSIN
Title: PRESIDENT
Phone: (608) 487-9067

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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