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General NPI Number Information
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NPI Number | 1760187975
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Entity Type | Organization
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Legal Business Name | EVERGREEN HOLISTIC HEALING
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 801 COMPASS WAY STE 217
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7818
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Country | US
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Telephone | 443-942-7817
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Fax | 443-458-7246
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Provider Business Mailing Address
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Address Line | 801 COMPASS WAY STE 217
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7818
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Country | US
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Telephone | 443-782-7901
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Fax | 443-548-7246
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SARA JAYE FENTON
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Credential |
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Telephone | 443-942-7817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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