EVERGREEN HEALTH SERVICES, LLC (NPI# 1578704466) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578704466 |
| Entity Type | Organization |
| Organization Name | EVERGREEN HEALTH SERVICES, LLC |
| Practice Address |
4276 Legend Ave Fayetteville NC 28303-1965 |
| Mailing Address |
Po Box 425 1409 Pinckney Street Whiteville NC 28472-0425 |
| Practice Telephone | 9108670035 |
| Practice Fax Number | 9108670545 |
| Mailing Telephone | 9106405551 |
| Mailing Fax Number | 9106410606 |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2009-03-23 |
| Authorized Official Name | MR. BRENTON BLAKE BYRD (CEO) |
| Authorized Official Telephone | 9106405512 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
4276 LEGEND AVE |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28303-1965 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679777494 | Neil Blue | Counselor | 4276 Legend Ave, Suite C, Fayetteville, NC 28303-1965 | 2007-06-14 |
| 1790186765 | Shekeema Schultz | Counselor | 4276 Legend Ave, Fayetteville, NC 28303-3497 | 2014-09-10 |
| 1558646661 | Ashley Poole | Counselor | 4276 Legend Ave, Fayetteville, NC 28303-1965 | 2011-10-20 |
| 1801113899 | James Anthony Vales Sr. | Social Worker | 4276 Legend Ave, Fayetteville, NC 28303-1965 | 2010-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801404496 | Matthew Pace | Physician Assistant | Bldg 5-4257 Bastogne St, Fort Bragg, NC 28303 | 2020-07-20 |
| 1952920449 | Vonetta Bethea Jackson | Social Worker | 391 Wagoner Drive, Fayetteville, NC 28303 | 2020-04-14 |
| 1932746229 | Julie Harriss | Specialist/Technologist | Bldg E 4062, Canopy Lane, Fort Bragg, NC 28303 | 2019-12-05 |
| 1235780354 | Helen Delores Johnson | Technician | 261 Pierron Dr, Fayetteville, NC 28303 | 2019-09-20 |
| 1922655075 | Andrea Margaret Hutnam | Technician | 714 Shortridge Rd, Fayetteville, NC 28303 | 2019-08-23 |
| 1225695273 | Breona Lister | Dental Hygienist | 38 17 Gruber Rd, Fort Bragg, NC 28303 | 2019-05-24 |
| 1780148957 | Brian K Cox Sr. | Occupational Therapy Assistant | 5300 Ramsey St, Fayetteville, NC 28303 | 2019-01-22 |
| 1730670902 | Michael Sadtler | Counselor | 804 Stamper Rd Ste 101, Fayetteville, NC 28303 | 2018-05-23 |
| 1104320399 | Tia Porterfield | Counselor | 2018 Fort Bragg Rd Ste 112a, Fayetteville, NC 28303 | 2018-03-21 |
| 1154835577 | Jessica Bass Bosworth | Psychologist | 3415 Youngstown Dr, Fayetteville, NC 28303 | 2017-11-21 |
| Find all providers in zip 28303 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124683032 | Red Earth Acupuncture | Clinic/Center | 1836 Highway 54 W, Fayetteville, GA 30214-4742 | 2019-05-06 |
| 1477033728 | Swetnam Cosmetic Surgery, Pllc | Clinic/Center | 1695 E Rainforest Rd Ste 3, Fayetteville, AR 72703-5385 | 2018-08-16 |
| 1023500725 | Greenbrook Tms Fayetteville LLC | Clinic/Center | 1991 Fordham Dr Ste 202, Fayetteville, NC 28304-3774 | 2018-05-30 |
| 1871013367 | Shiloh Health and Longevity | Clinic/Center | 1794 E Joyce Blvd Ste 1, Fayetteville, AR 72703-5257 | 2017-06-26 |
| 1942687900 | St Marys Hca of South Carolina | Clinic/Center | 2603 Cumberland Gap Drive, Suite 203, Fayetteville, NC 28306 | 2015-04-29 |
| 1407017965 | Correctiona Medical Associates | Clinic/Center | 205 Mcintosh Place Dr, Fayetteville, GA 30214-7384 | 2008-06-18 |
| 1376728154 | Massage Therapeutics, Inc Center for Wellness | Clinic/Center | 500 Lanier Ave W Ste 411, Fayetteville, GA 30214-7638 | 2007-12-30 |
| 1578767299 | Kidzplex Fitness | Clinic/Center | 1830q Owen Dr, Fayetteville, NC 28304-3421 | 2007-06-14 |
| 1114067519 | Rediclinic LLC | Clinic/Center | 3911 North Mall Avenue, Fayetteville, AR 72703 | 2007-02-07 |
| 1932202447 | Appalachian Regional Healthcare | Clinic/Center | 436 Elizabeth Way, Fayetteville, WV 25840 | 2006-09-07 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28303 |
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| 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.