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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