Provider Demographics
NPI:1861607517
Name:EVERGREEN COMMONS, INC.
Entity type:Organization
Organization Name:EVERGREEN COMMONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THE DAY CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-352-9029
Mailing Address - Street 1:480 STATE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4832
Mailing Address - Country:US
Mailing Address - Phone:616-396-7100
Mailing Address - Fax:616-396-9736
Practice Address - Street 1:480 STATE ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4832
Practice Address - Country:US
Practice Address - Phone:616-396-7100
Practice Address - Fax:616-396-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care