Provider Demographics
NPI:1073168142
Name:EVERGREEN FUND
Entity Type:Organization
Organization Name:EVERGREEN FUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHOHET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-899-9115
Mailing Address - Street 1:8033 W SUNSET BLVD STE 1053
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2401
Mailing Address - Country:US
Mailing Address - Phone:323-899-9115
Mailing Address - Fax:323-870-8200
Practice Address - Street 1:329 N WETHERLY DR STE 207
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1675
Practice Address - Country:US
Practice Address - Phone:323-899-9115
Practice Address - Fax:323-870-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health