EVERGREEN PINES INC (NPI# 1851721344) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851721344 |
| Entity Type | Organization |
| Organization Name | EVERGREEN PINES INC |
| Practice Address |
343 E Cumberland St Berlin WI 54923-1206 |
| Mailing Address |
Po Box 506 Sparta WI 54656-0506 |
| Practice Telephone | 9202903305 |
| Mailing Telephone | 9202293664 |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2013-11-19 |
| Authorized Official Name | KERI M HAYWOOD (PRESIDENT) |
| Authorized Official Telephone | 9202293664 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 14846 | WI | Residential Treatment Facilities |
| Street Address |
343 E CUMBERLAND ST |
| City | BERLIN |
| State | WI |
| Zip Code | 54923-1206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053910067 | Mary Ellen F Pumper | Pharmacist | 861 County Rd F, Berlin, WI 54923 | 2020-10-21 |
| 1962020792 | Brown Wilcox Trustees, Inc. | Home Health | 347 East Huron Street, Berlin, WI 54923 | 2020-07-08 |
| 1083050942 | Veterinary Clinic Berlin/ripon | Veterinarian | W1915 Cty Road F, Berlin, WI 54923 | 2013-05-20 |
| 1114078243 | David Earl Johanknecht | Optometrist | 269 Memorial Dr, Suite 103, Berlin, WI 54923 | 2007-01-16 |
| 1043314677 | William Harold Hastreiter | Dentist | 102 W Huron St, Berlin, WI 54923 | 2006-09-12 |
| 1699725333 | Kurt Alan Zemke | Dentist | 280 South Church St, Berlin, WI 54923 | 2006-05-11 |
| 1942280821 | Dina N Nelson | Nurse Anesthetist, Certified Registered | 225 Memorial Drive, Anesthesia Dept, Berlin, WI 54923 | 2006-01-18 |
| 1679574453 | Craig Batley | Family Medicine | W832 Hwy 91, Suite 3, Berlin, WI 54923 | 2005-08-03 |
| 1477043313 | Lina D Ramos | Registered Nurse | 225 Memorial Dr, Berlin, WI 54923 | 2018-05-16 |
| 1760887392 | Waushara Dental Associate Sc | Dentist | 322 Broadway, Berlin, WI 54923 | 2014-10-24 |
| Find all providers in zip 54923 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679913487 | Berlin Pines, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 642 Broadway, Berlin, WI 54923-1302 | 2013-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093252140 | Apria Residential Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2833 S 12th St, Sheboygan, WI 53081-6703 | 2017-01-27 |
| 1316482920 | Cheryl Mcmahon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2483 28th St, Rice Lake, WI 54868-9098 | 2017-01-05 |
| 1093174765 | Diane Cook | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12489 State Highway 56, Viola, WI 54664-8914 | 2016-02-23 |
| 1467810788 | Stonebrick Residential Living Facility LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4703 W Villard Ave, Milwaukee, WI 53218-4459 | 2016-02-01 |
| 1932574670 | Gayle Millis | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3260 E Carollton Dr, Oak Creek, WI 53154-4165 | 2015-12-07 |
| 1942605670 | Methu Adult Family Care Home II | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2824 N 59th St, Milwaukee, WI 53210-1504 | 2014-10-23 |
| 1720498736 | Kaiser Adult Family Care, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | W782 Leroy St, Edgar, WI 54426-9627 | 2014-04-29 |
| 1245502053 | Gloria Aweke | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1111 Gas Light Dr, Sun Prairie, WI 53590-3459 | 2012-02-08 |
| 1144500331 | Cedar Pines, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 101 W Division St, Wautoma, WI 54982-8467 | 2011-08-19 |
| 1912214966 | Sumac Residential LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 723 B Blue Jay Lane, Hudson, WI 54016 | 2010-09-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.