NPIMap

Organization Active NPI

Evergreen Treatment Services

  • Methadone Clinic
  • Renton, WA
National Provider Identifier
1417405333
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
17 0163 00 Issued in WA
Legal business name
EVERGREEN TREATMENT SERVICES
Practice address
1412 SW 43Rd St
Suite 140
Renton, WA 98057-4803
Phone
(425) 264-0750
Fax
(425) 264-0799
NPI assigned
Sep 20, 2016
Organization subpart
Yes
Parent organization
EVERGREEN TREATMENT SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Authorized official

Name
Margaret Carney
Title
Executive Director
Phone
(206) 223-3644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X 17 0163 00 WA Primary

Addresses

Primary practice location

1412 SW 43Rd St
Suite 140
Renton, WA 98057-4803

Mailing address

1700 Airport Way S
Seattle, WA 98134-1618
Phone (206) 223-3644

Other identifiers 1

IdentifierTypeStateIssuer
8008203MedicaidWA

National Provider Directory

National Provider Directory
Part of
Evergreen Treatment Services Unit 3

Locations

1412 SW 43rd St
Ste 140
Renton, WA 98057
Phone (425) 264-0750

NPI Registry JSON

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

{
    "created_epoch": "1474329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491868800000",
    "number": "1417405333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 AIRPORT WAY S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981341618",
            "telephone_number": "206-223-3644",
            "fax_number": "206-223-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1412 SW 43RD ST",
            "address_2": "SUITE 140",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574803",
            "telephone_number": "425-264-0750",
            "fax_number": "425-264-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN TREATMENT SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN TREATMENT SERVICES",
        "enumeration_date": "2016-09-20",
        "last_updated": "2017-04-11",
        "status": "A",
        "authorized_official_last_name": "CARNEY",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "206-223-3644"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "WA",
            "license": "17 0163 00",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8008203",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.