NPIMap

Organization Active NPI

Evergreen Presbyterian Ministries of Texas, Inc.

Doing business as Evergreen Life Services

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Texarkana, TX
National Provider Identifier
1073976171
Registry record updated Apr 5, 2016
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 TEXAS, INC.
Doing business as
Evergreen Life Services
Practice address
1319 Magnolia St
Texarkana, TX 75501-4440
Phone
(903) 794-0517
NPI assigned
Apr 5, 2016
Last updated
Apr 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2016

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

Authorized official

Name
Mr. Merlon Kent Craft
Title
Executive Vice President / Cfo
Phone
(318) 949-5515

Specialties & licenses 1

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

Addresses

Primary practice location

1319 Magnolia St
Texarkana, TX 75501-4440

Mailing address

2101 Highway 80
Haughton, LA 71037-9488
Phone (318) 949-5500

Other names 1

  • Evergreen Life Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Presbyterian Ministries of Texas Inc33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1073976171",
    "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": "318-949-5500",
            "fax_number": "318-949-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 MAGNOLIA ST",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755014440",
            "telephone_number": "903-794-0517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PRESBYTERIAN MINISTRIES OF TEXAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "CRAFT",
        "authorized_official_first_name": "MERLON",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT / CFO",
        "authorized_official_telephone_number": "318-949-5515",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Life Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; 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.