Provider Demographics
NPI:1255203493
Name:EVERGREEN HEALTH INSTITUTE
Entity type:Organization
Organization Name:EVERGREEN HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:304-860-2012
Mailing Address - Street 1:11605 MERIDIAN MARKET VW STE 124
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8238
Mailing Address - Country:US
Mailing Address - Phone:719-377-5152
Mailing Address - Fax:304-451-0033
Practice Address - Street 1:11528 LOUVRE PT
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-8225
Practice Address - Country:US
Practice Address - Phone:719-377-5152
Practice Address - Fax:304-451-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare