EVERGREEN RECOVERY NPI 1992152821

NPI Information

NPI: 1992152821
Provider Name: EVERGREEN RECOVERY
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 24D2167397

Address:
1400 ENERGY PARK DR
SUITE 21
SAINT PAUL, MN
ZIP 55108
Phone: (651) 252-6070
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EVERGREEN RECOVERY is a rehabilitation and substance use disorder clinic center in Saint Paul, MN. EVERGREEN RECOVERY NPI is 1992152821. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1400 ENERGY PARK DR
SUITE 21
SAINT PAUL, MN
ZIP 55108-272
Phone: (651) 252-6070
Fax: (651) 252-6071

The provider's authorized official is David Backus .
The authorized official title is Executive Director and has the following contact phone number (651) 252-6070.

The CLIA number assigned to this NPI record is 24D2167397 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 5/20/2016 and was last updated on 3/11/2020.

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	101YA0400X	Counselor	Addiction (Substance Use Disorder)	303683	MINNESOTA	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	303672	MINNESOTA	No
3	101YP2500X	Counselor	Professional	1204	MINNESOTA	No
4	101YA0400X	Counselor	Addiction (Substance Use Disorder)	304003	MINNESOTA	No
5	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

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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