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NPI Code Detail

MEDICARE: EVERGREEN PRESBYTERIAN MINISTRIES, INC.

MEDICARE: EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPCA 3327LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851445993
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Provider Business Mailing Address
First Line : 2101 HIGHWAY 80
Second Line :
City : HAUGHTON
State : LA
Zip : 71037-9488
Country : US
Telephone Number : 318-949-5500
Fax Number :
Provider Business Practice Location Address
First Line : 1146 HODGES ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-5216
Country : US
Telephone Number : 337-433-9495
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JOHN R TAYLOR
Credential :
Telephone Number : 318-949-5500
Provider Enumeration Date : 01/23/2007
Last Update Date : 06/13/2008

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