Organization
EVERGREEN PRESBYTERIAN MINISTRIES, INC.
Active
Other names
Evergreen Supported Living Program-SWLA
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R TAYLOR (PRESIDENT)
(318) 949-5500
Entity
Organization
Contact information
Practice address
1146 HODGES ST, LAKE CHARLES, LA 70601-5216
(337) 433-9495
Mailing address
2101 HIGHWAY 80, HAUGHTON, LA 71037-9488
(318) 949-5500
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
SIL 2548
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1925624
—
LA
Enumeration date
01/24/2007
Last updated
06/13/2008
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