Provider Demographics
NPI:1255145819
Name:EVERGREEN HOLISTIC HEALING LLC
Entity type:Organization
Organization Name:EVERGREEN HOLISTIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PARKER
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-544-8964
Mailing Address - Street 1:415 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-1403
Mailing Address - Country:US
Mailing Address - Phone:715-544-8964
Mailing Address - Fax:
Practice Address - Street 1:415 N FRONT ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1403
Practice Address - Country:US
Practice Address - Phone:715-544-8964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain