EVERGREEN RECOVERY (NPI# 1992152821) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992152821 |
| Entity Type | Organization |
| Organization Name | EVERGREEN RECOVERY |
| Practice Address |
1400 Energy Park Dr Suite 21 Saint Paul MN 55108-5272 |
| Practice Telephone | 6512526070 |
| Practice Fax Number | 6512526071 |
| Mailing Telephone | 6512526070 |
| Mailing Fax Number | 6512526071 |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2020-03-11 |
| Authorized Official Name | DAVID BACKUS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6512526070 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
303683 | MN | Behavioral Health & Social Service Providers |
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
303672 | MN | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
1204 | MN | Behavioral Health & Social Service Providers |
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
304003 | MN | Behavioral Health & Social Service Providers |
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972967479 | Evergreen Recovery | Substance Abuse Rehabilitation Facility | 2601 Summit Ave, Everett, WA 98201-3309 | 2016-04-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | EVERGREEN RECOVERY CENTERS | 11627 Airport Rd Ste B, Everett, WA 98204-8714 |
| Colorado Business Entities | EVERGREEN RECOVERY SYSTEMS, LLC | 3001 Arrowhead Rd, Laporte, CO 80535 |
| Street Address |
1400 ENERGY PARK DR SUITE 21 |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55108-5272 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285088864 | Jordan Favia | Counselor | 1400 Energy Park Dr, Saint Paul, MN 55108-5272 | 2016-04-20 |
| 1679927248 | David Backus | Counselor | 1400 Energy Park Dr, Suite 21, Saint Paul, MN 55108-5272 | 2016-04-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306490677 | Kyle Leonard Bernier | Student in an Organized Health Care Education/Training Program | 1295 Bandana Blvd W, Suite 210, St. Paul, MN 55108 | 2019-07-25 |
| 1356870778 | Kathleen Louise Kocon | Marriage & Family Therapist | 2230 Como Ave., Saint Paul, MN 55108 | 2017-06-08 |
| 1871965830 | Jill Hansen | Specialist | 1449 Clevland Ave N, The Emily Program, Saint Paul, MN 55108 | 2015-10-29 |
| 1871821140 | Angela Joyce Anderson | Speech-Language Pathologist | 2266 Hillside Avenue, Saint Paul, MN 55108 | 2009-11-25 |
| 1265769418 | Dakota Baker | Counselor | 1360 Energy Park Drive Suite 340, St. Paul, MN 55108 | 2009-11-09 |
| 1255583449 | Suzanne Elizabeth Trunnell | Nurse Practitioner | 1020 Bandana Blvd. W, Aspen Medical Group--bandana Square, St. Paul, MN 55108 | 2008-10-21 |
| 1982851358 | Kimberly Joy Bahma | Pharmacist | 1295 Bandana Blvd, Suite 335, Saint Paul, MN 55108 | 2008-08-27 |
| 1952566093 | Caring Professionals Homecare, LLC | Home Health | 1543 Como Ave Ste 101, Saint Paul, MN 55108 | 2008-07-28 |
| 1700077344 | Archana Mani | Dentist | 1021 Bandana Blvd E Ste 121, Saint Paul, MN 55108 | 2007-08-08 |
| 1457554735 | Catherine Lawrence Scharlau | Psychologist | 1295 Bandana Blvd. North, Aspen Medical Group-behavioral Health, St. Paul, MN 55108 | 2007-06-06 |
| Find all providers in zip 55108 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285095778 | Wild River Services | Clinic/Center | 1246 University Ave W Ste 101, Saint Paul, MN 55104-4125 | 2016-03-11 |
| 1205446044 | Breakthrough | Clinic/Center | 2147 University Ave W, Saint Paul, MN 55114-1313 | 2020-08-06 |
| 1639798101 | American Indian Family Center | Clinic/Center | 579 Wells St, Saint Paul, MN 55130-4134 | 2020-04-14 |
| 1104309434 | Roots Recovery | Clinic/Center | 393 Dunlap St N Ste 736, Saint Paul, MN 55104-4205 | 2018-09-12 |
| 1730696857 | Brenda A Nelson | Clinic/Center | 220 Robert St S Ste 104, Saint Paul, MN 55107-1626 | 2018-01-10 |
| 1821504937 | New Way Treatment Center LLC | Clinic/Center | 220 Robert St S Ste 104, Saint Paul, MN 55107-1626 | 2017-12-27 |
| 1033655329 | Elite Recovery | Clinic/Center | 1145 Grand Ave, Saint Paul, MN 55105-2629 | 2017-01-11 |
| 1891152039 | Nurturing House, LLC | Clinic/Center | 540 Fairview Ave N Ste 303, Saint Paul, MN 55104-1796 | 2016-01-19 |
| 1164737326 | Community Addiction Recovery Enterprise- | Clinic/Center | 444 Lafayette Rd N, Saint Paul, MN 55155-3802 | 2010-08-12 |
| 1801003090 | Conceptual Counseling, Inc. | Clinic/Center | 287 6th St E, Ste 300, Saint Paul, MN 55101-1654 | 2007-05-17 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55108 |
Please comment or provide details below to improve the information on EVERGREEN RECOVERY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.