Organization
EVERGREEN CONGREGATE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM CORTLAND GREEN (OWNER)
(949) 397-0658
Entity
Organization
Contact information
Practice address
823 TOWNE ST, COSTA MESA, CA 92627-3509
(949) 397-0658
Mailing address
27702 CROWN VALLEY PKWY, LADERA RANCH, CA 92694-0608
(949) 397-0658
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/10/2022
Last updated
02/10/2022
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