| Evergreen Manor | |
|
2601 Summit Ave Everett WA 98201-3309 | |
| (425) 258-2407 | |
| Not Available |
| Full Name | Evergreen Manor |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 2601 Summit Ave, Everett, Washington |
| Authorized Official Name and Position | Marcia Broude (OFFICE MANAGER) |
| Authorized Official Contact | 4252582407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Manor 2601 Summit Ave Everett WA 98201-3309 Ph: (425) 258-2407 | Evergreen Manor 2601 Summit Ave Everett WA 98201-3309 Ph: (425) 258-2407 |
| NPI Number | 1760712400 |
|---|---|
| Provider Enumeration Date | 12/31/2009 |
| Last Update Date | 12/31/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760712400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CP00006404 (Washington) | Primary |
| 101YM0800X | Counselor - Mental Health | LH00010886 (Washington) | Secondary |
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