Organization
EVERGREEN PRESBYTERIAN MINISTRIES,INC.
Active
Other names
Fulton Road Community Home
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS RYLAND (REGIONAL VICE PRESIDENT)
(318) 949-5500
Entity
Organization
Contact information
Practice address
3207 MADONNA DR, ALEXANDRIA, LA 71301-4816
(318) 487-6500
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
2102860318
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1718009
—
LA
Enumeration date
01/08/2007
Last updated
05/30/2025
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