Evergreen Presbyterian Ministries, Inc.
Organization Active NPI Intellectual Disabilities Intermediate Care Facility · Covington, LA
NPI 1003962838 · NPPES record last updated Jun 16, 2008
Key facts
- NPI
- 1003962838
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual Disabilities Intermediate Care Facility 315P00000X
- License
- 733 (LA)
- Legal business name
- EVERGREEN PRESBYTERIAN MINISTRIES, INC.
- Practice address
- 11 Patricia Dr
Covington, LA 70433-1042 - Phone
- (985) 809-7661
- NPI assigned
- Jan 26, 2007
- Organization subpart
- No
Authorized official
- Name
- John R Taylor
- Title
- President
- Phone
- (318) 949-5500
Corporate family (same tax ID) 12
National Provider Directory
- Tax ID family
- Evergreen Ok Ther Leave Vocational Support
Locations
2101 Highway 80
Haughton, LA 71037
Phone (318) 949-5515
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | 733 | LA | Yes |
Addresses
Primary practice location
11 Patricia Dr
Covington, LA 70433-1042
Mailing address
2101 Highway 80
Haughton, LA 71037-9488
Phone (318) 949-5500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1719901 | Medicaid | LA |
Other names
- River Forest Community Home
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.