Provider Demographics
NPI:1700981768
Name:EVERGREEN YOUTH AND FAMILY SERVICES, INC
Entity type:Organization
Organization Name:EVERGREEN YOUTH AND FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR AND FACILITIES & SAFETY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-308-9066
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-0622
Mailing Address - Country:US
Mailing Address - Phone:218-308-9006
Mailing Address - Fax:218-751-8070
Practice Address - Street 1:610 PATRIOT DR NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4570
Practice Address - Country:US
Practice Address - Phone:218-308-9006
Practice Address - Fax:218-751-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN140171800OtherMHCP