| Evergreen 2 | |
|
111 Elwyn Rd Media PA 19063-4622 | |
| (610) 891-7007 | |
| (610) 891-2666 |
| Full Name | Evergreen 2 |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 111 Elwyn Rd, Media, Pennsylvania |
| Authorized Official Name and Position | Donna K Busch (PAYER CONTRACT SPECIALIST) |
| Authorized Official Contact | 4452063028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen 2 111 Elwyn Rd Media PA 19063-4622 Ph: (610) 891-7007 | Evergreen 2 111 Elwyn Rd Media PA 19063-4622 Ph: (610) 891-7007 |
| NPI Number | 1215548615 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 03/07/2022 |
| Certification Date | 03/07/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215548615 | NPI | - | NPPES |
| 1000021240700 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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