Organization
EVERGREEN PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONY HANSON (ADMINISTRATOR-CEO)
(701) 349-3312
Entity
Organization
Contact information
Practice address
241 MAIN STREET, ELLENDALE, ND 58436
(701) 349-4550
(701) 349-4656
Mailing address
201 8TH ST N, ELLENDALE, ND 58436-7341
(701) 349-4550
(701) 349-4656
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
30729
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30729
—
ND
Enumeration date
03/27/2007
Last updated
08/22/2020
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