Organization
EVERGREEN MANOR SENIOR CARE CENTRE, LLC
Active
Other names
Evergreen Senior Care and Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
TODD SANGSTER (CFO)
(810) 534-0150
Entity
Organization
Contact information
Practice address
111 EVERGREEN RD, SPRINGFIELD, MI 49037-7417
(269) 969-6110
(269) 969-6710
Mailing address
10503 CITATION DR STE 100, BRIGHTON, MI 48116-6551
(810) 534-0150
(810) 534-0208
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
134160
MI
332BN1400X
Nursing Facility Supplies (DME)
134160
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09903
BCBSM
MI
01
—
0A30320
BCBS DME P&O
MI
05
—
4406078
—
MI
Enumeration date
01/10/2007
Last updated
05/05/2022
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