Provider Demographics
NPI:1407403611
Name:EVERGREEN HEALTH, LLC
Entity Type:Organization
Organization Name:EVERGREEN HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING ACCOUNT MANA
Authorized Official - Phone:207-662-4500
Mailing Address - Street 1:29 BOWDOIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04351-3554
Mailing Address - Country:US
Mailing Address - Phone:207-622-4500
Mailing Address - Fax:207-622-5452
Practice Address - Street 1:29 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:ME
Practice Address - Zip Code:04351-3554
Practice Address - Country:US
Practice Address - Phone:207-622-4500
Practice Address - Fax:207-622-5452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty