Organization
EVERGREEN RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BACKUS (EXECUTIVE DIRECTOR)
(651) 252-6070
Entity
Organization
Contact information
Practice address
1400 ENERGY PARK DR, SUITE 21, SAINT PAUL, MN 55108-5272
(651) 252-6070
(651) 252-6071
Mailing address
1400 ENERGY PARK DR, SUITE 21, SAINT PAUL, MN 55108-5272
(651) 252-6070
(651) 252-6071
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
303672
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
303683
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
304003
MN
101YP2500X
Professional Counselor
1204
MN
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
05/20/2016
Last updated
03/11/2020
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