Organization
EVERGREEN CARE CENTER LLC
Active
Other names
D/B/A ATRIUM POST ACUTE CARE OF SHAWANO AT EVERGREEN
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT M PARKINS (CFO)
(920) 364-9754
Entity
Organization
Contact information
Practice address
1250 S EVERGREEN ST, SHAWANO, WI 54166-3514
(715) 526-3107
(715) 524-8037
Mailing address
1726 N BALLARD RD, APPLETON, WI 54911-2444
(920) 991-9072
(920) 749-4021
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2896
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20192000
—
WI
Enumeration date
08/19/2005
Last updated
05/27/2015
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