NPIMap

Organization Active NPI

Evergreen Behavioral Management

  • Community/Behavioral Health Agency
  • Lumberton, NC
National Provider Identifier
1043459647
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EVERGREEN BEHAVIORAL MANAGEMENT
Practice address
220 G & H Wintergreen Dr
Lumberton, NC 28358
Phone
(910) 738-9420
Fax
(910) 671-9414
NPI assigned
Feb 5, 2009
Last updated
Mar 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Ginger G Gore
Title
Owner
Phone
(910) 640-5512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

220 G & H Wintergreen Dr
Lumberton, NC 28358

Mailing address

PO Box 425
Whiteville, NC 28472-0425
Phone (910) 640-5512

Other identifiers 1

IdentifierTypeStateIssuer
8300536MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Management14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1043459647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 425",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284720425",
            "telephone_number": "910-640-5512",
            "fax_number": "910-641-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 G & H WINTERGREEN DR",
            "city": "LUMBERTON",
            "state": "NC",
            "postal_code": "28358",
            "telephone_number": "910-738-9420",
            "fax_number": "910-671-9414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN BEHAVIORAL MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "GINGER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-640-5512",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300536",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lumberton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.