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EVERGREEN CENTER FOR INTEGRATIVE MEDICINE PLLC

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Company Details

Legal Name: EVERGREEN CENTER FOR INTEGRATIVE MEDICINE PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: April 29th 2021
Expiration date: 30 Apr 2026
UBI Number: 604 745 580
ZIP code: 98115
City: Seattle
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 2008 NE 65TH ST, SEATTLE, WA, 98115-6934, UNITED STATES

Contact Details

E-Mail: ADMIN@EVERGREENCENTER.NET
Phone Number: +1 206-729-0907

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
BOBBI LUTACK Registered Agent 2008 NE 65TH ST, SEATTLE, WA, 98115-6934, UNITED STATES

Key Officers & Management

Name Role Address
BOBBI LUTACK Executor 2008 NE 65TH ST, SEATTLE, WA, 98115-6934, UNITED STATES
BOBBI LUTACK Governing Person 2008 NE 65TH ST, SEATTLE, WA, 98115-6934, UNITED STATES

National Provider Identifier

NPI Number:
1194483289
Certification Date:
2021-12-06

Authorized Person:

Name:
AMANDA BAKER
Role:
PRACTICE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2067290199
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