NPIMap

Organization Active NPI

Evergreen Recovery

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Saint Paul, MN
National Provider Identifier
1992152821
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
EVERGREEN RECOVERY
Practice address
1400 Energy Park Dr
Suite 21
Saint Paul, MN 55108-5272
Phone
(651) 252-6070
Fax
(651) 252-6071
NPI assigned
May 20, 2016
Last updated
Mar 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Authorized official

Name
David BackusNPI 1679927248
Title
Executive Director
Phone
(651) 252-6070

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 303683 MN
Addiction (Substance Use Disorder) Counselor 101YA0400X 303672 MN
Addiction (Substance Use Disorder) Counselor 101YA0400X 304003 MN
Professional Counselor 101YP2500X 1204 MN

Addresses

Primary practice location

1400 Energy Park Dr
Suite 21
Saint Paul, MN 55108-5272

Mailing address

1400 Energy Park Dr
Suite 21
Saint Paul, MN 55108-5272
Phone (651) 252-6070

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Recovery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1400 Energy Park Dr
Ste 21
Saint Paul, MN 55108
Phone (651) 252-6070

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1992152821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 ENERGY PARK DR",
            "address_2": "SUITE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085272",
            "telephone_number": "651-252-6070",
            "fax_number": "651-252-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 ENERGY PARK DR",
            "address_2": "SUITE 21",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551085272",
            "telephone_number": "651-252-6070",
            "fax_number": "651-252-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-20",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "BACKUS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-252-6070"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303683",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303672",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "304003",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "1204",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; 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.