Provider Demographics
NPI:1174823413
Name:EVERGREEN BEHAVIORAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:EVERGREEN BEHAVIORAL MANAGEMENT, INC.
Other - Org Name:BRENTON HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:G
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-641-0600
Mailing Address - Street 1:1409 PINCKNEY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-2220
Mailing Address - Country:US
Mailing Address - Phone:910-641-0600
Mailing Address - Fax:910-641-0606
Practice Address - Street 1:5794 OLD US HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-6779
Practice Address - Country:US
Practice Address - Phone:910-641-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility