Provider Demographics
NPI:1417938580
Name:EVERGREEN WOODS
Entity Type:Organization
Organization Name:EVERGREEN WOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, ADMINISTRATOR
Authorized Official - Phone:203-488-8000
Mailing Address - Street 1:88 NOTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1846
Mailing Address - Country:US
Mailing Address - Phone:203-483-3205
Mailing Address - Fax:203-483-3202
Practice Address - Street 1:88 NOTCH HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1846
Practice Address - Country:US
Practice Address - Phone:203-483-3205
Practice Address - Fax:203-483-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2189C314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2189COtherFACILITY LICENSE NUMBER
CT2189COtherFACILITY LICENSE NUMBER