NPI 1033447776

Evergreen Manor III, INC

Organisation Mental Illness Community Based Residential Treatment Facility Sparta, WI

Practice location

Address: 8429 Idyllview Ave, Sparta, WI 54656-3617
Phone: (608) 487-9067
Fax: (608) 487-9067

Authorised official

Name: Larenda L Rosin
Title: President
Phone: (608) 487-9067

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence 0011807 (WI)

Other Community Based Residential Treatment Facility, Mental Illness providers in Wisconsin →

Registry record

NPI: 1033447776
Entity type: Organization
NPI issued: 18 Nov 2009
Record last updated: 18 Nov 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.