Evergreen Recovery Clinical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EVERGREEN RECOVERY CLINICAL LABORATORY

Practice address

1400 Energy Park Dr Ste 21
Saint Paul, MN 55108-5248

Phone

(651) 252-6078

Fax

(651) 252-6071

NPI assigned

Jan 17, 2023

Organization subpart

Yes

Parent organization

EVERGREEN RECOVERYAs reported in NPPES

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

Authorized official

Name

Heather L Heim, CPRS

Title

Chief Operating Officer

Phone

(651) 252-6078

Specialties & licenses 1

Addresses

Tax ID family

Evergreen Recovery2 organizations share this tax ID, including this one

Part of

Evergreen Recovery

Other organizations with this tax ID 1

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

• Evergreen Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Saint Paul, MN
  • NPI 1992152821
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Evergreen Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Saint Paul, MN
  • NPI 1992152821
  NPPES parent name

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawn Grygo, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Saint Paul, MN
  • NPI 1023698099
  NPD
• Shane Ryan Hawley, ADC-T, MS

  • Mental Health Counselor
  • Saint Paul, MN
  • NPI 1861275059
  NPD
• David Backus

  • Counselor
  • Saint Paul, MN
  • NPI 1679927248
  NPD (past)

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

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1801501523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 ENERGY PARK DR STE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085248",
            "telephone_number": "651-252-6078",
            "fax_number": "651-252-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 ENERGY PARK DR STE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085248",
            "telephone_number": "651-252-6078",
            "fax_number": "651-252-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RECOVERY CLINICAL LABORATORY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN RECOVERY",
        "enumeration_date": "2023-01-17",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "HEIM",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "651-252-6078",
        "authorized_official_credential": "CPRS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evergreen Chiropractic
• Evergreen Health Services PLC
• Evergreen Home Healthcare
• Evergreen Mental Health Services, Inc
• Evergreen Recovery
• Sarah Jane Evergreen, LCSW
• Charles Everingham
• Rachel Everson-Fink, CCC-SLP
• Evoke Therapy Services, LLC
• Evolve Mental Health

• Clinical Medical Laboratory in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Medical Laboratory in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.