Organization
EVERGREEN RETIREMENT COMMUNITY, INC.
Active
Parent organization
EVERGREEN RETIREMENT COMMUNITY, INC.
Other names
Evergreen At Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVERGREEN RETIREMENT COMMUNITY, INC.
Authorized official
MRS. PEGGY BELLIN RN (ADMINISTRATOR)
(920) 237-2140
Entity
Organization
Contact information
Practice address
1125 N WESTFIELD ST, OSHKOSH, WI 54902-3216
(920) 237-6205
(920) 966-0334
Mailing address
1125 N WESTFIELD ST, OSHKOSH, WI 54902-3216
(844) 654-7600
(920) 966-0334
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1186
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100049268
—
WI
01
—
527321
PTAN
WI
Enumeration date
08/09/2013
Last updated
07/29/2022
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