Provider Demographics
NPI:1558508564
Name:EVERGREEN FAMILY FOCUS, LLC
Entity Type:Organization
Organization Name:EVERGREEN FAMILY FOCUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:CISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:920-469-1201
Mailing Address - Street 1:2475 UNIVERSITY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-5099
Mailing Address - Country:US
Mailing Address - Phone:920-469-1201
Mailing Address - Fax:920-469-3404
Practice Address - Street 1:2475 UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-5099
Practice Address - Country:US
Practice Address - Phone:920-469-1201
Practice Address - Fax:920-469-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty