| Evergreen Community Supports, Llc | |
|
316b Steam Shovel Road Stanton KY 40380 | |
| (859) 644-2584 | |
| Not Available |
| Full Name | Evergreen Community Supports, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 316b Steam Shovel Road, Stanton, Kentucky |
| Authorized Official Name and Position | Deana Carol Pack (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8596442584 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Community Supports, Llc 104 Old Bottom Road Winchester KY 40391 Ph: (859) 644-2584 | Evergreen Community Supports, Llc 316b Steam Shovel Road Stanton KY 40380 Ph: (859) 644-2584 |
| NPI Number | 1154653897 |
|---|---|
| Provider Enumeration Date | 02/05/2010 |
| Last Update Date | 02/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154653897 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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