NPIMap

Organization Active NPI

Evergreen Behavioral Management, Inc.

  • Community/Behavioral Health Agency
  • Fayetteville, NC
National Provider Identifier
1679712277
Registry record updated Mar 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EVERGREEN BEHAVIORAL MANAGEMENT, INC.
Practice address
4276 Legend Ave Ste C
Fayetteville, NC 28303-3497
Phone
(910) 867-0035
Fax
(910) 867-0545
NPI assigned
Feb 5, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2009

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

Authorized official

Name
Ms. Ginger G Gore
Title
Owner
Phone
(910) 640-5512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

4276 Legend Ave Ste C
Fayetteville, NC 28303-3497

Mailing address

PO Box 425
Whiteville, NC 28472-0425
Phone (910) 640-5512

Other identifiers 1

IdentifierTypeStateIssuer
8300806MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Behavioral Mana14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

4276 Legend Ave
Ste C
Fayetteville, NC 28303
Phone (910) 485-6843

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": "1233792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236902400000",
    "number": "1679712277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 425",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284720425",
            "telephone_number": "910-640-5512",
            "fax_number": "910-641-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4276 LEGEND AVE STE C",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283033497",
            "telephone_number": "910-867-0035",
            "fax_number": "910-867-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN BEHAVIORAL MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-05",
        "last_updated": "2009-03-13",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "GINGER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-640-5512",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300806",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; 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.