Organization
EVERGREEN TERRACE ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDI MICHALSKI (ADMINISTRATOR)
(231) 527-1050
Entity
Organization
Contact information
Practice address
801 FULLER AVE, BIG RAPIDS, MI 49307-2106
(231) 527-1050
Mailing address
3196 KRAFT AVE SE, GRAND RAPIDS, MI 49512-2078
(616) 464-1564
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL540279286
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D1102189
CLIA
MI
Enumeration date
11/17/2009
Last updated
11/17/2009
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