Provider Demographics
NPI:1659198091
Name:EVERGREEN HEALTH AND LIFE
Entity type:Organization
Organization Name:EVERGREEN HEALTH AND LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO, NP
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:BITTO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP, PMHNP
Authorized Official - Phone:240-934-0090
Mailing Address - Street 1:100 MIDDLETOWN PKWY
Mailing Address - Street 2:SUITE 202 PMB# 40
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MIDDLETOWN PKWY
Practice Address - Street 2:SUITE 202 PMB# 40
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769
Practice Address - Country:US
Practice Address - Phone:240-934-0090
Practice Address - Fax:240-348-8621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health