NPIMap

Organization Active NPI

Evergreen Presbyterian Ministries of Texas, Inc.

Doing business as Evergreen Pebblecreek Community Home

  • Intellectual Disabilities Intermediate Care Facility
  • Garland, TX
National Provider Identifier
1932246956
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
117343 Issued in TX
Legal business name
EVERGREEN PRESBYTERIAN MINISTRIES OF TEXAS, INC.
Doing business as
Evergreen Pebblecreek Community Home
Practice address
530 Pebblecreek Dr
Garland, TX 75040-3605
Phone
(972) 496-9243
NPI assigned
Jan 31, 2007
Last updated
Jun 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 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 117343 TX Primary

Addresses

Primary practice location

530 Pebblecreek Dr
Garland, TX 75040-3605

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
001001610MedicaidTX

Other names 1

  • Evergreen Pebblecreek Community Home 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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1932246956",
    "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": "530 PEBBLECREEK DR",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750403605",
            "telephone_number": "972-496-9243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PRESBYTERIAN MINISTRIES OF TEXAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2008-06-17",
        "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": "TX",
            "license": "117343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001001610",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Pebblecreek Community Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.