Evergreen Behavioral Health Center, Inc.

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

112 Issued in WV

Legal business name

EVERGREEN BEHAVIORAL HEALTH CENTER, INC.

Practice address

240 North St
New Martinsville, WV 26155-1771

Phone

(304) 455-4415

Fax

(304) 455-2501

NPI assigned

Sep 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. B. Mark Fetty, AB

Title

Executive Director

Phone

(304) 455-4415

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154412492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 NORTH ST",
            "city": "NEW MARTINSVILLE",
            "state": "WV",
            "postal_code": "261551771",
            "telephone_number": "304-455-4415",
            "fax_number": "304-455-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 NORTH ST",
            "city": "NEW MARTINSVILLE",
            "state": "WV",
            "postal_code": "261551771",
            "telephone_number": "304-455-4415",
            "fax_number": "304-455-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN BEHAVIORAL HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FETTY",
        "authorized_official_first_name": "B.",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-455-4415",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "AB"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WV",
            "license": "112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005321000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005321002",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005321001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ibanga Michael Ekanem, MD
• Zaki M Elsarrag, MD
• Edward Lee Emch, MD
• Kimberly Renee Ensminger
• Aimee Espy, COTA/L
• Carolyn S Farnsworth
• Seneca Ferrebee
• Cynthia Ferrell
• Trina Fetty
• Anthony Jenaro Figueroa Jr.

• Case Management Agency in New Martinsville, WV
• Providers in New Martinsville, WV by specialty
• Case Management Agency in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.