| Evergreen Health Care | |
|
733 W 40th St Suite 200 Baltimore MD 21211-2112 | |
| (443) 451-4993 | |
| Not Available |
| Full Name | Evergreen Health Care |
|---|---|
| Speciality | Counselor |
| Location | 733 W 40th St, Baltimore, Maryland |
| Authorized Official Name and Position | Jessica L Kohnen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4434514973 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Health Care 3000 Falls Rd Suite 1 Baltimore MD 21211-2474 Ph: (443) 963-2818 | Evergreen Health Care 733 W 40th St Suite 200 Baltimore MD 21211-2112 Ph: (443) 451-4993 |
| NPI Number | 1669860151 |
|---|---|
| Provider Enumeration Date | 01/06/2015 |
| Last Update Date | 01/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669860151 | NPI | - | NPPES |
| 5354021 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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