Provider Demographics
NPI:1114191293
Name:EVERGREEN HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:EVERGREEN HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-586-8498
Mailing Address - Street 1:2131 HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1740
Mailing Address - Country:US
Mailing Address - Phone:609-586-8498
Mailing Address - Fax:609-586-7678
Practice Address - Street 1:2131 HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1740
Practice Address - Country:US
Practice Address - Phone:609-586-8498
Practice Address - Fax:609-586-7678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty