Active NPI
Evergreen Healthcare Clinic Limited Liability Company
- Psychiatric/Mental Health Nurse Practitioner
- Baltimore, MD
National Provider Identifier
1659162402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- EVERGREEN HEALTHCARE CLINIC LIMITED LIABILITY COMPANY
- Practice address
- 300 N Charles St Ste D
Baltimore, MD 21201-4305 - Phone
- (240) 644-5570
- NPI assigned
- May 13, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Yvette Ledjo
- Title
- Ceo
- Phone
- (240) 644-5570
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | Primary |
Addresses
Primary practice location
300 N Charles St Ste D
Baltimore, MD 21201-4305
Mailing address
13707 Crownsgate Way
Germantown, MD 20874-4424
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Evergreen Healthcare Clinic Limited Liability Company
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Nurse Practitioner
- Baltimore, MD
- NPI 1831039395
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747094400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1783382400000",
"number": "1659162402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13707 CROWNSGATE WAY",
"city": "GERMANTOWN",
"state": "MD",
"postal_code": "208744424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N CHARLES ST STE D",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212014305",
"telephone_number": "240-644-5570"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVERGREEN HEALTHCARE CLINIC LIMITED LIABILITY COMPANY",
"organizational_subpart": "NO",
"enumeration_date": "2025-05-13",
"last_updated": "2026-07-07",
"certification_date": "2026-07-07",
"status": "A",
"authorized_official_last_name": "LEDJO",
"authorized_official_first_name": "YVETTE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "240-644-5570"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.