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Contact Information

EVERGREEN MANOR SENIOR CARE CENTRE, LLC
111 EVERGREEN RD
SPRINGFIELD, MI49037-7417
 Phone: 269-969-6110
 Fax: 269-969-6710
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility Supplies

332BN1400X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for EVERGREEN MANOR SENIOR CARE CENTRE, LLC

NPI Number 1992855316
LBN Legal business name EVERGREEN MANOR SENIOR CARE CENTRE, LLC
Authorized official TODD SANGSTER - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 01/10/2007
Last updated 05/05/2022 - About 4 years ago
Identifiers
MI License # 134160
MI Medicaid 4406078
MI Other 0A30320 BCBS DME P&O
MI Other 09903 BCBSM
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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