Evergreen Presbyterian Ministries, Inc.
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Bossier City, LA
NPI 1104965409 · NPPES record last updated May 27, 2025
Key facts
- NPI
- 1104965409
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- License
- SIL 4606 (LA)
- Legal business name
- EVERGREEN PRESBYTERIAN MINISTRIES, INC.
- Practice address
- 3907 Shed Rd
Bossier City, LA 71111-5214 - Phone
- (318) 747-9855
- NPI assigned
- Feb 5, 2007
- Organization subpart
- No
Authorized official
- Name
- Douglas Ryland
- Title
- Regional Vice President
- Phone
- (318) 949-5500
Corporate family (same tax ID) 19
National Provider Directory
- Tax ID family
- Evergreen Ok Ther Leave Vocational Support
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | SIL 4606 | LA | Yes |
Addresses
Primary practice location
3907 Shed Rd
Bossier City, LA 71111-5214
Mailing address
2101 Highway 80
Haughton, LA 71037-9488
Phone (318) 949-5500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1918768 | Medicaid | LA |
Other names
- NWLA Supported Living Program
Other providers in Bossier City, LA
- Endovascular Technologies, LLC
- Alexandra English
- Sarah Estess
- Ethicus Hospital-Shreveport, LLC
- Michael Evans
- Evergreen Presbyterian Ministries, Inc.
- Evergreen Presbyterian Ministries, Inc.
- Evergreen Presbyterian Ministries, Inc.
- Evergreen Presbyterian Ministries, Inc.
- Evergreen Presbyterian Ministries, Inc.
All providers in Bossier City, LA · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2025. 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.