Evergreen Manor Detox

LBN: Evergreen Manor Detox
Evergreen Manor Detox is an health care organization with primary practice located at 2601 Summit Ave , Everett WA 98201. The organization recently has only one registered license in Residential Treatment Facilities / Substance Abuse Rehabilitation Facility, which is considered as the primary health care specialty. Evergreen Manor Detox can be contacted via phone (425) 258-2407, or through Grant, Linda K via phone (425) 258-2407.

Contact Information

Primary practice address
2601 Summit Ave Everett WA 98201
Phone: (425) 258-2407
Fax: (425) 339-2601
Website:
Map and Directions
Authorized official contact:
Name: Grant, Linda K MS CDP
Phone: (425) 258-2407

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Substance Abuse Rehabilitation Facility 324500000X 31089100 Washington

Profile Details

NPI number 1205965159
LBN Legal business name Evergreen Manor Detox
DBA Doing business as
Authorized official Grant, Linda K MS CDP
Entity Organization
Organization subpart 1 Yes
Enumeration date Mar 5th, 2007
Last updated Oct 30th, 2007 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205965159 NPPES
Washington MEDICAID 1994177

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