Provider Demographics
NPI:1588184980
Name:EVERGREEN RECOVERY CENTERS-LYNNWOOD DETOX
Entity type:Organization
Organization Name:EVERGREEN RECOVERY CENTERS-LYNNWOOD DETOX
Other - Org Name:<UNAVAIL>
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:425-493-5310
Mailing Address - Fax:425-263-9706
Practice Address - Street 1:20508 56TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-678-1390
Practice Address - Fax:425-678-8611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN RECOVERY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-27
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility