Provider Demographics
NPI:1578874111
Name:EVERGREEN AIDS FOUNDATION
Entity Type:Organization
Organization Name:EVERGREEN AIDS FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT SERVICES ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WESTERGREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-671-0703
Mailing Address - Street 1:1509 CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4521
Mailing Address - Country:US
Mailing Address - Phone:360-671-0703
Mailing Address - Fax:360-671-9882
Practice Address - Street 1:1509 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4521
Practice Address - Country:US
Practice Address - Phone:360-671-0703
Practice Address - Fax:360-671-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management