Provider Demographics
NPI:1124159157
Name:EVERGREEN RECOVERY CENTERS
Entity type:Organization
Organization Name:EVERGREEN RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF QUALITY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-343-4599
Mailing Address - Street 1:PO BOX 12598
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206
Mailing Address - Country:US
Mailing Address - Phone:425-258-2407
Mailing Address - Fax:425-339-2601
Practice Address - Street 1:2732 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3416
Practice Address - Country:US
Practice Address - Phone:425-259-5842
Practice Address - Fax:425-339-2601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN RECOVERY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31 1095 00261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1990746Medicaid