Organization
EVERGREEN INDEPENDANT LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY HANKS (OWNER/CEO)
(406) 231-6293
Entity
Organization
Contact information
Practice address
3805 7TH ST NE TRLR 74, GREAT FALLS, MT 59404-1152
(406) 231-6293
Mailing address
PO BOX 249, BLACK EAGLE, MT 59414-0249
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
10/17/2012
Last updated
10/17/2012
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