Organization
EVERGREEN PINES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERI M HAYWOOD (PRESIDENT)
(920) 229-3664
Entity
Organization
Contact information
Practice address
343 E CUMBERLAND ST, BERLIN, WI 54923-1206
(920) 290-3305
Mailing address
PO BOX 506, SPARTA, WI 54656-0506
(920) 229-3664
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
14846
WI
Other
Enumeration date
11/19/2013
Last updated
11/19/2013
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