NPIMap

Organization Active NPI

Evergreen Presbyterian Ministries,Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Alexandria, LA
National Provider Identifier
1215085626
Registry record updated May 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2102860318 Issued in LA
Legal business name
EVERGREEN PRESBYTERIAN MINISTRIES,INC.
Practice address
3207 Madonna Dr
Alexandria, LA 71301-4816
Phone
(318) 487-6500
NPI assigned
Jan 8, 2007
Last updated
May 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2025

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

Authorized official

Name
Douglas Ryland
Title
Regional Vice President
Phone
(318) 949-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2102860318 LA Primary

Addresses

Primary practice location

3207 Madonna Dr
Alexandria, LA 71301-4816

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1718009MedicaidLA

Other names 1

  • Fulton Road Community Home Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215085626. Details of each certification follow.

  • CCN 19G095 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G095

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Fulton Road Community Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 9, 1983
Last certification
Aug 6, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
3207 Madonna Drive
Alexandria, LA 71301

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Ok Room Board Support120 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1215085626",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3207 MADONNA DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713014816",
            "telephone_number": "318-487-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PRESBYTERIAN MINISTRIES,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "RYLAND",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "REGIONAL VICE PRESIDENT",
        "authorized_official_telephone_number": "318-949-5500"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "2102860318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1718009",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fulton Road Community Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Alexandria, LA

Sources for this page

Verify at the official NPI Registry.