Provider Demographics
NPI:1275297384
Name:EVERGREEN RECOVERY CENTERS-HEALTH SERVICES
Entity type:Organization
Organization Name:EVERGREEN RECOVERY CENTERS-HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CQO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-343-4599
Mailing Address - Street 1:PO BOX 12598
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206
Mailing Address - Country:US
Mailing Address - Phone:425-493-5310
Mailing Address - Fax:425-263-9706
Practice Address - Street 1:20508 56TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-535-4243
Practice Address - Fax:425-835-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty