Organization
EVERGREEN BEHAVIORAL MANAGEMENT, INC.
Active
Parent organization
EVERGREEN BEHAVIORAL MANAGEMENT, INC.
Other names
Brenton House
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVERGREEN BEHAVIORAL MANAGEMENT, INC.
Authorized official
MS. GINGER GAYLE GORE (CEO)
(910) 641-0600
Entity
Organization
Contact information
Practice address
5794 OLD HIGHWAY 74, CHADBOURN, NC 28431-6779
(910) 654-3591
(910) 654-3591
Mailing address
PO BOX 425, WHITEVILLE, NC 28472-0425
(910) 641-0600
(910) 641-0606
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL024074
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603239
—
NC
Enumeration date
10/21/2008
Last updated
10/21/2008
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