Organization
EVERGREEN PRESBYTERIAN MINISTRIES OF TEXAS, INC.
Active
Other names
Evergreen Stone Trail Community Home
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R TAYLOR (PRESIDENT)
(318) 949-5500
Entity
Organization
Contact information
Practice address
1205 STONE TRAIL ST, LONGVIEW, TX 75604-3533
(903) 693-8221
Mailing address
2101 HIGHWAY 80, HAUGHTON, LA 71037-9488
(318) 949-5500
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
115892
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000735901
—
TX
Enumeration date
01/29/2007
Last updated
07/15/2009
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