Evergreen Recovery LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

EVERGREEN RECOVERY LLC

Practice address

12 Randall St
Portland, ME 04103-5116

Phone

(781) 469-6505

NPI assigned

Apr 28, 2025

Organization subpart

No

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

Authorized official

Name

Amanda Terranova

Title

Program Coordinator

Phone

(617) 291-9224

Specialties & licenses 1

Addresses

Tax ID family

Evergreen Recovery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Evergreen Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Portland, ME
  • NPI 1053208710
  NPD tax ID

Locations

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

{
    "created_epoch": "1745798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745798400000",
    "number": "1245028604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 REDLON RD",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041022218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 RANDALL ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041035116",
            "telephone_number": "781-469-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-28",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-27",
        "status": "A",
        "authorized_official_last_name": "TERRANOVA",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PROGRAM COORDINATOR",
        "authorized_official_telephone_number": "617-291-9224"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Everest Care LLC
• Haley Dawn Everett, DC
• Evergreen Physical Therapy & Care
• Evergreen Psychotherapy
• Evergreen Recovery LLC
• Carole Ewald, LCSW
• Marissa Exchange
• Eyecare Medical Group
• Eyecare Medical Group
• Eyecare Medical Group

• Substance Abuse Rehabilitation Facility in Portland, ME
• Providers in Portland, ME by specialty
• Substance Abuse Rehabilitation Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.