Healthcare Provider Details

I. General information

NPI: 1043368442
Provider Name (Legal Business Name): EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 S ELM ST
HAUGHTON LA
71037-9684
US

IV. Provider business mailing address

2101 HIGHWAY 80
HAUGHTON LA
71037-9488
US

V. Phone/Fax

Practice location:
  • Phone: 318-949-5022
  • Fax:
Mailing address:
  • Phone: 318-949-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number713
License Number StateLA

VIII. Authorized Official

Name: DOUGLAS RYLAND
Title or Position: REGIONAL VICE PRESIDENT
Credential:
Phone: 318-949-5500