# EVERGREEN CONGREGATE, LLC

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

## Provider details

- **NPI number:** 1558015248
- **Authorized official:** ADAM CORTLAND GREEN (OWNER)
- **Authorized official phone:** (949) 397-0658

## Contact information

- **Practice address:** 823 TOWNE ST, COSTA MESA, CA 92627-3509
- **Practice address phone:** (949) 397-0658
- **Mailing address:** 27702 CROWN VALLEY PKWY, LADERA RANCH, CA 92694-0608
- **Mailing address phone:** (949) 397-0658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 02/10/2022
- **Last updated:** 02/10/2022