| Organization Name: | EVERGREEN PLACE LLC |
| NPI Number: | 1326445388 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BETH ANN MCGARRY (ADMINISTRATOR) |
| Mailing Address: | 23299 285th Ave Akeley |
| State: | MN US |
| Postal Code: | 564338020 |
| Phone Number: | 2186526702 |
| Fax Number: | 2186526710 |
| NPI Enumeration Date: | 11/19/2014 |
| NPI Last Update Date: | 11/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 1075464-1HCBS |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |