# EVERGREEN PINES INC

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

## Provider details

- **NPI number:** 1851721344
- **Authorized official:** KERI M HAYWOOD (PRESIDENT)
- **Authorized official phone:** (920) 229-3664

## Contact information

- **Practice address:** 343 E CUMBERLAND ST, BERLIN, WI 54923-1206
- **Practice address phone:** (920) 290-3305
- **Mailing address:** PO BOX 506, SPARTA, WI 54656-0506
- **Mailing address phone:** (920) 229-3664

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 14846 | WI | Yes |

## Other

- **Enumeration date:** 11/19/2013
- **Last updated:** 11/19/2013