NPIMap

Organization Active NPI

Evergreen Presbyterian Ministries of West TN

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Memphis, TN
National Provider Identifier
1063530442
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
EVERGREEN PRESBYTERIAN MINISTRIES OF WEST TN
Practice address
5154 Stage Rd
Suite 100
Memphis, TN 38134-3118
Phone
(901) 381-9370
Fax
(901) 381-9368
NPI assigned
Mar 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John R Taylor
Title
President
Phone
(318) 742-8440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

5154 Stage Rd
Suite 100
Memphis, TN 38134-3118

Mailing address

2101 Highway 80
Haughton, LA 71037-9488
Phone (318) 742-8440

Other identifiers 1

IdentifierTypeStateIssuer
00E21MedicaidTN

Other names 1

  • Evergreen Presbyterian Ministries, Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Ok Ther Leave Vocational Support120 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

5154 Stage Rd
Ste 100
Memphis, TN 38134
Phone (901) 381-9370

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063530442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 HIGHWAY 80",
            "city": "HAUGHTON",
            "state": "LA",
            "postal_code": "710379488",
            "telephone_number": "318-742-8440",
            "fax_number": "318-752-5448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5154 STAGE RD",
            "address_2": "SUITE 100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381343118",
            "telephone_number": "901-381-9370",
            "fax_number": "901-381-9368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PRESBYTERIAN MINISTRIES OF WEST TN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "318-742-8440"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00E21",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Presbyterian Ministries, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.