Evergreen Manor II

NPI #1457689192 in Sparta, Wisconsin

Provider Information

NPI Number: 1457689192
Entity Type: Organization
Organization Name: Evergreen Manor II
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Nov 18, 2009
Last Updated: Nov 18, 2009

Practice Location

Address: 8429 IDYLLVIEW AVE
City: Sparta
State: Wisconsin
ZIP Code: 54656-3617
Phone: (608) 487-9067

Authorized Official

Name: MRS. 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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