Provider Demographics
NPI:1316393531
Name:EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Entity Type:Organization
Organization Name:EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT / CFO
Authorized Official - Prefix:
Authorized Official - First Name:MERLON
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-949-5515
Mailing Address - Street 1:2101 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-9488
Mailing Address - Country:US
Mailing Address - Phone:318-949-5500
Mailing Address - Fax:318-949-5555
Practice Address - Street 1:1538 CAMELLIA DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6228
Practice Address - Country:US
Practice Address - Phone:985-386-2360
Practice Address - Fax:985-386-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities