Provider Demographics
NPI:1992038905
Name:EVANSVILLE CARE CAMPUS LLC
Entity Type:Organization
Organization Name:EVANSVILLE CARE CAMPUS LLC
Other - Org Name:EVANSVILLE SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARLYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-948-2454
Mailing Address - Street 1:649 STATE ST NW
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56326-8124
Mailing Address - Country:US
Mailing Address - Phone:218-948-2219
Mailing Address - Fax:
Practice Address - Street 1:649 STATE ST NW
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:MN
Practice Address - Zip Code:56326-8124
Practice Address - Country:US
Practice Address - Phone:218-948-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility