Organization
EVERGREEN RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANAZAR D BEASLEY (OWNER)
(443) 826-8204
Entity
Organization
Contact information
Practice address
9637 LIBERTY RD STE G, RANDALLSTOWN, MD 21133-2452
(443) 826-8204
Mailing address
9637 LIBERTY RD STE G, RANDALLSTOWN, MD 21133-2452
(443) 826-8204
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
11/02/2023
Last updated
11/02/2023
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