Healthcare Provider Details

I. General information

NPI: 1306991849
Provider Name (Legal Business Name): EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SIBLEY RD
MINDEN LA
71055-5138
US

IV. Provider business mailing address

2101 HIGHWAY 80
HAUGHTON LA
71037-9488
US

V. Phone/Fax

Practice location:
  • Phone: 318-371-1961
  • Fax:
Mailing address:
  • Phone: 318-949-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberPCA 2856
License Number StateLA

VIII. Authorized Official

Name: JOHN R TAYLOR
Title or Position: PRESIDENT
Credential:
Phone: 318-949-5500