Provider Demographics
NPI:1760240493
Name:EVERGREEN MEADOW SERVICES INC
Entity Type:Organization
Organization Name:EVERGREEN MEADOW SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-346-4968
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:COCHECTON
Mailing Address - State:NY
Mailing Address - Zip Code:12726-0064
Mailing Address - Country:US
Mailing Address - Phone:833-346-4968
Mailing Address - Fax:
Practice Address - Street 1:111 SULLIVAN AVE STE 2-5
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-4317
Practice Address - Country:US
Practice Address - Phone:833-346-4968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty