NPIMap

Organization Active NPI

Evergreen Presbyterian Ministries, Inc.

Doing business as Twenty-Third Street Community Home

  • Intellectual Disabilities Intermediate Care Facility
  • Lake Charles, LA
National Provider Identifier
1356495485
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
747 Issued in LA
Legal business name
EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Doing business as
Twenty-Third Street Community Home
Practice address
1701 23Rd St
Lake Charles, LA 70601-8957
Phone
(337) 474-7252
NPI assigned
Jan 23, 2007
Last updated
Jun 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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) 949-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 747 LA Primary

Addresses

Primary practice location

1701 23Rd St
Lake Charles, LA 70601-8957

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1713023MedicaidLA

Other names 1

  • Twenty-Third Street Community Home Doing business as

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 1356495485. Details of each certification follow.

  • CCN 19G471 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 19G471

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
Twenty-Third Street Community Home
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 10, 1994
Last certification
Apr 29, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
1701 23rd Street
Lake Charles, LA 70601

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Presbyterian Ministries of West TN120 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

Locations

1701 23rd St
Lake Charles, LA 70601
Phone (337) 474-7252

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1356495485",
    "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": "1701 23RD ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018957",
            "telephone_number": "337-474-7252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PRESBYTERIAN MINISTRIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2008-06-13",
        "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": "318-949-5500"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "LA",
            "license": "747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1713023",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twenty-Third Street Community Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.