Organization
4 EVERGREEN RECOVERY HOMES AND SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COBLAH Q GREEN (OWNER)
(443) 908-5858
Entity
Organization
Contact information
Practice address
3210 VICKERS RD, BALTIMORE, MD 21216-1940
(443) 924-3754
Mailing address
3210 VICKERS RD, BALTIMORE, MD 21216-1940
(443) 924-3754
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
177F00000X
Lodging Provider
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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