EVERGREEN MANOR II – NPI #1457689192
Community Based Residential Treatment Facility, Mental Illness

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

Health Care Provider Taxonomy Code for Community Based Residential Treatment Facility, Mental Illness

EVERGREEN MANOR II is a community based residential treatment facility located in SPARTA, WI. NPPES has assigned the NPI number 1457689192 to EVERGREEN MANOR II on November 18, 2009. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 320800000X from the Health Care Provider Taxonomy code set, which is classified as Community Based Residential Treatment Facility, Mental Illness.

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for EVERGREEN MANOR II below.

NPI Profile for
EVERGREEN MANOR II

NPI Number
1457689192
Enumeration Date

(more than 16 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
EVERGREEN MANOR II
Primary location
8429 IDYLLVIEW AVE
SPARTA, WI 54656-3617
Phone: (608) 487-9067 Fax: (608) 487-9067
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
LARENDA ROSIN
PRESIDENT
Phone: (608) 487-9067
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320800000X
- Community Based Residential Treatment Facility, Mental Illness (Primary)		 WI 0011268

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.