Evergreen Group Home, LLC

NPI #1871638999 in Urbana, Missouri

Provider Information

NPI Number: 1871638999
Entity Type: Organization
Organization Name: Evergreen Group Home, LLC
Primary Specialty: Counselor - Mental Health
Enumeration Date: Feb 20, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 27 HOPPER TRL
City: Urbana
State: Missouri
ZIP Code: 65767-9234
Phone: (417) 722-4416

Authorized Official

Name: MR. GARY D BOGGS
Title: PRESIDENT
Phone: (417) 722-4416

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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