Organization
EVERGREEN COMMUNITY SUPPORTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEANA CAROL PACK (EXECUTIVE DIRECTOR)
(859) 644-2584
Entity
Organization
Contact information
Practice address
316B STEAM SHOVEL ROAD, STANTON, KY 40380
(859) 644-2584
Mailing address
104 OLD BOTTOM ROAD, WINCHESTER, KY 40391
(859) 644-2584
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/05/2010
Last updated
02/05/2010
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