Evergreen Community & Support Services LLC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Legal business name

EVERGREEN COMMUNITY & SUPPORT SERVICES LLC

Practice address

4123 Stonecrest CT # 102
Bellingham, WA 98226-7762

Phone

(954) 464-0256

NPI assigned

Oct 2, 2024

Last updated

Oct 2, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Costan Jaya Balgobin, B.A.

Title

Co-Owner

Phone

(954) 464-0256

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1727827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1346068731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 333",
            "city": "SEDRO WOOLLEY",
            "state": "WA",
            "postal_code": "982840333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4123 STONECREST CT # 102",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982267762",
            "telephone_number": "954-464-0256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN COMMUNITY & SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "BALGOBIN",
        "authorized_official_first_name": "COSTAN",
        "authorized_official_middle_name": "JAYA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "954-464-0256",
        "authorized_official_credential": "B.A."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ethan Spencer Evans
• Kelly L Evans, M.D.
• Richard J Evans V, MA
• Evergreen AIDS Foundation
• Evergreen at Bellingham, L.L.C. (North Cascades Health and Rehabilitation Center)
• Evergreen North Cascades Health & Rehab Ctr.
• Evergreen Psychiatry, LLC
• Evergreen Supported Living
• Matthew H Evoy Jr., CDP, CCC
• Jeannette Marie Evraets, RN LAC

• Case Manager/Care Coordinator in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Case Manager/Care Coordinator in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.