Organization
EVERGREEN ELM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARRY I PUGRANT (CEO)
(814) 362-6853
Entity
Organization
Contact information
Practice address
71 MAIN STREET, SUITE 303, BRADFORD, PA 16701-2029
(814) 362-6853
(814) 362-1048
Mailing address
71 MAIN STREET, SUITE 303, BRADFORD, PA 16701-2029
(814) 362-6853
(814) 362-1048
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
426070
PA
Other
Enumeration date
03/18/2008
Last updated
03/18/2008
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