Provider Demographics
NPI:1942874615
Name:EVERGREEN WELLNESS JOURNEYS, LLC
Entity Type:Organization
Organization Name:EVERGREEN WELLNESS JOURNEYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:NBCHWC
Authorized Official - Phone:240-844-1050
Mailing Address - Street 1:16501 SHADY GROVE RD UNIT 7082
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20898-6503
Mailing Address - Country:US
Mailing Address - Phone:240-844-1050
Mailing Address - Fax:
Practice Address - Street 1:5000 THAYER CENTER STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:240-844-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date: