Organization
EVERGREEN BEHAVIORAL HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. B. MARK FETTY AB (EXECUTIVE DIRECTOR)
(304) 455-4415
Entity
Organization
Contact information
Practice address
240 NORTH ST, NEW MARTINSVILLE, WV 26155-1771
(304) 455-4415
(304) 455-2501
Mailing address
240 NORTH ST, NEW MARTINSVILLE, WV 26155-1771
(304) 455-4415
(304) 455-2501
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
112
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005321000
—
WV
05
—
0005321001
—
WV
05
—
0005321002
—
WV
Enumeration date
09/28/2006
Last updated
08/22/2020
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