EVERGREEN MANOR,INC.
Residential Treatment Facilities at Idyllview Ave, Sparta, WI

License number
Wisconsin 0010512
Category
Residential Treatment Facilities
Type
Community Based Residential Treatment Facility, Mental Illness
Owner
Name: LARENDA L ROSIN
Title: PRESIDENT
Phone: (608) 487-9067
Address
Address
8429 Idyllview Ave, Sparta, WI 54656
National Provider ID: 1386972024
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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EVERGREEN MANOR, INC

Sparta, WI

Industry:
Business Services at Non-Commercial Site
Doing business as:
EVERGREEN MANOR III, INC<br>EVERGREEN MANOR II, INC<br>EVERGREEN MANOR I, INC
Registration:
Jan 30, 2004
Addresses:
8429 Idyllview Ave, Sparta, WI 54656 (Physical)
PO Box 506, Sparta, WI 54656
State ID:
E032697
Business type:
Domestic Business
Principals:
Larenda L. Rosin (President, Principal),L. Rosin Larenda Principal, inactive

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