Evergreen Manor - Residential 2

LBN: Evergreen Manor - Residential 2
Evergreen Manor - Residential 2 is an health care organization with primary practice located at 2601 Summit Ave , Everett WA 98201-3309. 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 - Residential 2 can be contacted via phone (425) 258-2407, or through Grant, Linda via phone (425) 258-2407.

Contact Information

Primary practice address
2601 Summit Ave Everett WA 98201-3309
Phone: (425) 258-2407
Fax: (425) 339-2601
Website:
Map and Directions
Authorized official contact:
Name: Grant, Linda MS CDP
Phone: (425) 258-2407

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Substance Abuse Rehabilitation Facility 324500000X 31-0108-02 Washington

Profile Details

NPI number 1093998312
LBN Legal business name Evergreen Manor - Residential 2
DBA Doing business as
Authorized official Grant, Linda MS CDP
Entity Organization
Organization subpart 1 Yes
Enumeration date Dec 10th, 2007
Last updated Dec 10th, 2007 - about 18 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 1093998312 NPPES
Washington MEDICAID 1995109

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