NPIMap

Organization Active NPI

Evergreen Treatment Services Unit 4

  • Methadone Clinic
  • Seattle, WA
National Provider Identifier
1558416685
Registry record updated Jul 9, 2026
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 UNIT 4
Practice address
1700 Airport Way S
Seattle, WA 98134-1618
Phone
(206) 223-3644
Fax
(202) 223-1482
NPI assigned
Jan 25, 2007
Last updated
Jul 9, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERGREEN TREATMENT SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2026

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

Authorized official

Name
Donavan Lam
Title
Cfo
Phone
(206) 690-1767

Specialties & licenses 1

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

Addresses

Primary practice location

1700 Airport Way S
Seattle, WA 98134-1618

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1995414MedicaidWA
8008203MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Treatment Services Unit 56 organizations share this tax ID, including this one
Part of
Evergreen Treatment Services Unit 5

Other organizations with this tax ID 5

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

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783555200000",
    "number": "1558416685",
    "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": "202-223-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 AIRPORT WAY S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981341618",
            "telephone_number": "206-223-3644",
            "fax_number": "202-223-1482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN TREATMENT SERVICES UNIT 4",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN TREATMENT SERVICES",
        "enumeration_date": "2007-01-25",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "DONAVAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "206-690-1767"
    },
    "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": "1995414",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8008203",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; 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.