Provider Demographics
NPI:1760187975
Name:EVERGREEN HOLISTIC HEALING
Entity Type:Organization
Organization Name:EVERGREEN HOLISTIC HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JAYE
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-942-7817
Mailing Address - Street 1:801 COMPASS WAY STE 217
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7818
Mailing Address - Country:US
Mailing Address - Phone:443-782-7901
Mailing Address - Fax:443-548-7246
Practice Address - Street 1:801 COMPASS WAY STE 217
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7818
Practice Address - Country:US
Practice Address - Phone:443-942-7817
Practice Address - Fax:443-458-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service