Organization · Type 2 NPI
Evergreen Manor Iii, Inc
Mental Illness Community Based Residential Treatment Facility · Sparta, WI
NPI number
1033447776
Active
Practice location
8429 Idyllview Ave
Sparta, WI 54656-3617
Fax (608) 487-9067
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Illness Community Based Residential Treatment Facility Primary | 320800000X | 0011807 (WI) |
Mental Illness Community Based Residential Treatment Facility: A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
2 other providers at this address
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About NPI 1033447776
Evergreen Manor Iii, Inc's National Provider Identifier is 1033447776, issued on Nov 18, 2009. The primary taxonomy on file is Mental Illness Community Based Residential Treatment Facility (320800000X), and the practice location is in Sparta, WI. The record was last updated on Nov 18, 2009.