Healthcare Provider Details

I. General information

NPI: 1417822099
Provider Name (Legal Business Name): EVERGREEN HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11528 LOUVRE POINT
PEYTON CO
80831
US

IV. Provider business mailing address

11605 MERIDIAN MARKET VW STE 124
FALCON CO
80831-8238
US

V. Phone/Fax

Practice location:
  • Phone: 719-377-5152
  • Fax: 304-451-0033
Mailing address:
  • Phone: 719-377-5152
  • Fax: 304-451-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE T GREEN
Title or Position: CEO
Credential: FNP-C
Phone: 304-860-2012