Organization
EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Active
Other names
Dubberly Group Home
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R TAYLOR (PRESIDENT)
(318) 949-5500
Entity
Organization
Contact information
Practice address
1241 JACK MARTIN RD, MINDEN, LA 71055-6384
(318) 377-9190
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
678
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1719498
—
LA
Enumeration date
01/24/2007
Last updated
06/16/2008
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