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General NPI Number Information
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NPI Number | 1861607517
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Entity Type | Organization
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Legal Business Name | EVERGREEN COMMONS, INC.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 480 STATE ST
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City | HOLLAND
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State | MI
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Zip | 49423-4832
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Country | US
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Telephone | 616-396-7100
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Fax | 616-396-9736
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Provider Business Mailing Address
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Address Line | 480 STATE ST
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City | HOLLAND
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State | MI
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Zip | 49423-4832
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Country | US
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Telephone | 616-396-7100
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Fax | 616-396-9736
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Authorized Official
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Title or Position | DIRECTOR OF THE DAY CENTER
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Name | MRS. SUZZANNE SHOLES
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Credential |
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Telephone | 269-352-9029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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