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EVERGREEN PRESBYTERIAN MINISTRIES INC. NPI 1922147222


NPI Information

NPI: 1922147222
Provider Name: EVERGREEN PRESBYTERIAN MINISTRIES, INC.

Doing Business As: EVERGREEN SUPPORTED EMPLOYMENT-NWLA

Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
3907 SHED RD
BOSSIER CITY, LA
ZIP 71111
Phone: (318) 747-9855
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EVERGREEN PRESBYTERIAN MINISTRIES, INC. is a community based residential treatment facility, intellectual and/or developmental disabilities in Bossier City, LA. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. EVERGREEN PRESBYTERIAN MINISTRIES, INC. NPI is 1922147222. The provider is registered as an organization entity type.
The provider Is Doing Business As Evergreen Supported Employment-nwla.

The provider's business location address is:

3907 SHED RD
BOSSIER CITY, LA
ZIP 71111-214
Phone: (318) 747-9855

The provider's authorized official is John R Taylor .
The authorized official title is President and has the following contact phone number (318) 949-5500.

The enumeration date for this NPI number is 2/5/2007 and was last updated on 6/12/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesSIL 4606LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11654175MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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