Provider Demographics
NPI:1609355668
Name:EVERGREEN BEHAVIORAL LLC
Entity Type:Organization
Organization Name:EVERGREEN BEHAVIORAL LLC
Other - Org Name:WOBURN WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIERCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ALIBERTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-572-2578
Mailing Address - Street 1:53 CUMMINGS PARK
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 CUMMINGS PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2123
Practice Address - Country:US
Practice Address - Phone:339-999-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0212324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility