Provider Demographics
NPI:1679998066
Name:EVERGREEN EMPOWERMENT GROUP INC
Entity Type:Organization
Organization Name:EVERGREEN EMPOWERMENT GROUP INC
Other - Org Name:EEG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-703-0067
Mailing Address - Street 1:35104 EUCLID AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4566
Mailing Address - Country:US
Mailing Address - Phone:216-703-0067
Mailing Address - Fax:
Practice Address - Street 1:35104 EUCLID AVE STE 314
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4566
Practice Address - Country:US
Practice Address - Phone:216-703-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-22
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health