# EVERGREEN HAVEN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104616002
- **Authorized official:** MR. LARRY ROBERT HIGGINBOTHAM (OWNER)
- **Authorized official phone:** (417) 850-3063

## Contact information

- **Practice address:** 445 E 10TH ST, BAXTER SPRINGS, KS 66713-1614
- **Practice address phone:** (620) 304-2108
- **Practice address fax:** (620) 304-2109
- **Mailing address:** PO BOX 92, RACINE, MO 64858-0092
- **Mailing address phone:** (417) 850-3063
- **Mailing address fax:** (620) 304-2109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/12/2025
- **Last updated:** 05/12/2025