NPIMap

Organization Active NPI

Evergreen Behavioral Management Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Whiteville, NC
National Provider Identifier
1790860971
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
EVERGREEN BEHAVIORAL MANAGEMENT INC
Practice address
1409 Pinckney St
Whiteville, NC 28472-2220
Phone
(910) 641-0600
Fax
(910) 641-0606
NPI assigned
Oct 26, 2006
Last updated
May 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Authorized official

Name
Ginger G. Gore, CEO OWNER OF COMPANY
Title
Ceo
Phone
(910) 641-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1409 Pinckney St
Whiteville, NC 28472-2220

Mailing address

PO Box 425
Whiteville, NC 28472-0425
Phone (910) 641-0600

Other identifiers 2

IdentifierTypeStateIssuer
89015VMMedicaidNC
6005966MedicaidNC

National Provider Directory

National Provider Directory

Locations

1107 W Broad St
Elizabethtown, NC 28337
Phone (919) 641-0600

211 E Six Forks Rd
Ste 114
Raleigh, NC 27609
Phone (919) 218-4444

2250 Shipyard Blvd
Ste 3
Wilmington, NC 28403
Phone (910) 791-9625

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368662400000",
    "number": "1790860971",
    "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": "910-641-0600",
            "fax_number": "910-641-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 PINCKNEY ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284722220",
            "telephone_number": "910-641-0600",
            "fax_number": "910-641-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN BEHAVIORAL MANAGEMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2013-05-16",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "GINGER",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-641-0600",
        "authorized_official_credential": "CEO OWNER OF COMPANY"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89015VM",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005966",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; 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.