Organization
EVERGREEN HOPE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEO SHINDANO DEO (OWNER)
(763) 406-6111
Entity
Organization
Contact information
Practice address
5701 KENTUCKY AVE N, CRYSTAL, MN 55428-3370
(763) 923-8817
Mailing address
5701 KENTUCKY AVE N, CRYSTAL, MN 55428-3370
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/06/2025
Last updated
06/06/2025
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