Healthcare Provider Details

I. General information

NPI: 1508792649
Provider Name (Legal Business Name): EVERGREEN TREATMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PULASKI HWY
HAVRE DE GRACE MD
21078-2127
US

IV. Provider business mailing address

PO BOX 417
HAVRE DE GRACE MD
21078-0417
US

V. Phone/Fax

Practice location:
  • Phone: 410-273-9300
  • Fax:
Mailing address:
  • Phone: 410-273-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERICA GATER
Title or Position: COOWNER
Credential: CSC-AD
Phone: 410-273-9300