Provider Demographics
NPI:1386399335
Name:EVERGREEN FUND
Entity type:Organization
Organization Name:EVERGREEN FUND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:N/S
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHOHET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-899-9115
Mailing Address - Street 1:8033 W SUNSET BLVD # 1053
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14475 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1733
Practice Address - Country:US
Practice Address - Phone:424-242-2760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility