| NPI | 1215548615 |
|---|---|
| Other Name | EVERGREEN 2 |
| Entity Type | Organization |
| Authorized Contact | DONNA K BUSCH Payer Contract Specialist 445-206-3028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2022-03-07 |