EVERGREEN TREATMENT SERVICES NPI 1417405333

NPI Information

NPI: 1417405333
Provider Name: EVERGREEN TREATMENT SERVICES
Classification: Clinic/Center - 261QM2800X
Entity Type: Organization

Specialization: Methadone

CLIA Number: 50D2116265

Address:
1412 SW 43RD ST
SUITE 140
RENTON, WA
ZIP 98057
Phone: (425) 264-0750
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EVERGREEN TREATMENT SERVICES is a methadone clinic center in Renton, WA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. EVERGREEN TREATMENT SERVICES NPI is 1417405333. The provider is registered as an organization entity type.

The provider's business location address is:

1412 SW 43RD ST
SUITE 140
RENTON, WA
ZIP 98057-803
Phone: (425) 264-0750
Fax: (425) 264-0799

The provider's authorized official is Margaret Carney .
The authorized official title is Executive Director and has the following contact phone number (206) 223-3644.

The CLIA number assigned to this NPI record is 50D2116265 - other - drug treatment with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/20/2016 and was last updated on 4/11/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM2800X	Clinic/Center	Methadone	17 0163 00	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8008203	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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