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Organization
JOHNSON EVERGREEN CORPORATION
Active
Organization
JOHNSON EVERGREEN CORPORATION
Active
Other names
Evergreen Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNA ROMANOWSKI (DIRECTOR OF REIMBURSEMENT)
(860) 684-8714
Entity
Organization
Contact information
Practice address
205 CHESTNUT HILL RD, STAFFORD SPRINGS, CT 06076-4005
(860) 684-8714
(860) 684-8723
Mailing address
205 CHESTNUT HILL RD, STAFFORD SPRINGS, CT 06076-4005
(860) 684-8714
(860) 684-8723
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2081-C
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000020529
—
CT
01
—
44044
WELLCARE
CT
01
—
712385
CONNECTICARE PROVIDER NUM
CT
01
—
833
ANTHEM BLUE CROSS BLUE SHIELD
CT
01
—
A3796830
OXFORD
CT
Enumeration date
08/23/2006
Last updated
05/14/2015
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