Organization
EVERGREEN HOME OF BERLIN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARENDA L ROSIN (PRESIDENT)
(608) 487-9067
Entity
Organization
Contact information
Practice address
508 E MARQUETTE ST, BERLIN, WI 54923-9404
(920) 361-3231
(920) 361-3231
Mailing address
8429 IDYLLVIEW AVE, SPARTA, WI 54656-3617
(608) 487-9067
(608) 487-9067
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/06/2010
Last updated
01/06/2010
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