Provider Demographics
NPI:1720520810
Name:YOUR HEALTH NETWORK
Entity Type:Organization
Organization Name:YOUR HEALTH NETWORK
Other - Org Name:EVERGREEN HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-451-3873
Mailing Address - Street 1:9710 PATUXENT WOODS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1526
Mailing Address - Country:US
Mailing Address - Phone:301-575-8080
Mailing Address - Fax:
Practice Address - Street 1:9710 PATUXENT WOODS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1526
Practice Address - Country:US
Practice Address - Phone:301-575-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22259261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care