# EVERGREEN COMMUNITY & SUPPORT SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346068731
- **Authorized official:** COSTAN JAYA BALGOBIN B.A. (CO-OWNER)
- **Authorized official phone:** (954) 464-0256

## Contact information

- **Practice address:** 4123 STONECREST CT \# 102, BELLINGHAM, WA 98226-7762
- **Practice address phone:** (954) 464-0256
- **Mailing address:** PO BOX 333, SEDRO WOOLLEY, WA 98284-0333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 10/02/2024
- **Last updated:** 10/02/2024