| Evergreen Therapy Llc | |
|
6601 S 70th St Lincoln NE 68516-3602 | |
| (402) 401-7560 | |
| Not Available |
| Full Name | Evergreen Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 6601 S 70th St, Lincoln, Nebraska |
| Authorized Official Name and Position | Jonae N Cunningham (DIRECT OWNER) |
| Authorized Official Contact | 4024017560 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Therapy Llc 6601 S 70th St Lincoln NE 68516-3602 Ph: (402) 401-7560 | Evergreen Therapy Llc 6601 S 70th St Lincoln NE 68516-3602 Ph: (402) 401-7560 |
| NPI Number | 1932814662 |
|---|---|
| Provider Enumeration Date | 01/17/2023 |
| Last Update Date | 01/17/2023 |
| Certification Date | 01/17/2023 |
| Medicare PECOS PAC ID | 7618340670 |
|---|---|
| Medicare Enrollment ID | O20230222002910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932814662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Jonae Cunningham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518358753 PECOS PAC ID: 8527431584 Enrollment ID: I20230222003024 |
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