Organization
EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Active
Other names
Country Club 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
98 COUNTRY CLUB DR, PINEVILLE, LA 71360-2656
(318) 640-4996
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
530
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1717860
—
LA
Enumeration date
01/22/2007
Last updated
05/30/2025
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