Organization
EVERGREEN SUPPORTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ZAY AIDAN SMITH MCSHANE (EXECUTIVE DIRECTOR)
(360) 671-5898
Entity
Organization
Contact information
Practice address
305 FLORA ST, BELLINGHAM, WA 98225-4430
(360) 671-5898
(360) 922-0648
Mailing address
305 FLORA ST, BELLINGHAM, WA 98225-4430
(360) 671-5898
(360) 922-0648
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
06/02/2022
Last updated
06/02/2022
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