Provider Demographics
NPI:1639297005
Name:EVERGREEN PRESBYTERIAN MINISTRIES OF MIDDLE TN
Entity Type:Organization
Organization Name:EVERGREEN PRESBYTERIAN MINISTRIES OF MIDDLE TN
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 1:446 METROPLEX DR
Practice Address - Street 2:SUITE A-224
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3139
Practice Address - Country:US
Practice Address - Phone:615-833-9500
Practice Address - Fax:615-833-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
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
TN00940Medicaid