Organization
EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Active
Other names
Ravendale 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
815 RAVENDALE DR, SHREVEPORT, LA 71107-4026
(318) 424-8457
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
496
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1717355
—
LA
Enumeration date
01/08/2007
Last updated
05/27/2025
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