Provider Demographics
NPI:1538287669
Name:EVERGREEN OK TRANSPORTATION
Entity Type:Organization
Organization Name:EVERGREEN OK TRANSPORTATION
Other - Org Name:EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-742-8440
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:318-742-8440
Mailing Address - Fax:318-752-5448
Practice Address - Street 1:7725 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1507
Practice Address - Country:US
Practice Address - Phone:405-720-1192
Practice Address - Fax:405-720-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100645750E-G320Medicaid