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General NPI Number Information
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NPI Number | 1215085626
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Entity Type | Organization
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Legal Business Name | EVERGREEN PRESBYTERIAN MINISTRIES,INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 3207 MADONNA DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-4816
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Country | US
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Telephone | 318-487-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 HIGHWAY 80
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City | HAUGHTON
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State | LA
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Zip | 71037-9488
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Country | US
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Telephone | 318-949-5500
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Fax |
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Authorized Official
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Title or Position | REGIONAL VICE PRESIDENT
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Name | DOUGLAS RYLAND
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Credential |
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Telephone | 318-949-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 2102860318
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License Number State | LA
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