Organization
EVERGREEN COMMUNITY & SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COSTAN JAYA BALGOBIN B.A. (CO-OWNER)
(954) 464-0256
Entity
Organization
Contact information
Practice address
4123 STONECREST CT # 102, BELLINGHAM, WA 98226-7762
(954) 464-0256
Mailing address
PO BOX 333, SEDRO WOOLLEY, WA 98284-0333
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/02/2024
Last updated
10/02/2024
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