Evergreen Health Care Center

LBN: Johnson Evergreen Corporation
Evergreen Health Care Center is an health care organization with primary practice located at 205 Chestnut Hill Rd , Stafford Springs CT 06076-4005. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. Johnson Evergreen Corporation can be contacted via phone (860) 684-8714, or through Romanowski, Anna via phone (860) 684-8714.

Contact Information

Primary practice address
205 Chestnut Hill Rd Stafford Springs CT 06076-4005
Fax: (860) 684-8723
Website:
Authorized official contact:
Name: Romanowski, Anna

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 2081-C Connecticut

Profile Details

NPI number 1053427609
LBN Legal business name Johnson Evergreen Corporation
DBA Doing business as Evergreen Health Care Center
Authorized official Romanowski, Anna
Entity Organization
Organization subpart 1 No
Enumeration date Aug 23rd, 2006
Last updated May 14th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053427609 NPPES
Connecticut Other 712385 CONNECTICARE PROVIDER NUM
Connecticut Other 44044 CONNECTICARE PROVIDER NUM
Connecticut Other A3796830 CONNECTICARE PROVIDER NUM
Connecticut MEDICAID 000020529 CONNECTICARE PROVIDER NUM
Connecticut Other 833 CONNECTICARE PROVIDER NUM

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