Organization Name: | EVERGREEN PRESBYTERIAN MINISTRIES, INC. |
NPI Number: | 1306294731 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MERLON KENT CRAFT (EXECUTIVE VICE PRESIDENT / CFO) |
Mailing Address: | 21147 Highway 22 Ponchatoula |
State: | LA US |
Postal Code: | 704547941 |
Phone Number: | 9853862360 |
Fax Number: | 9853869380 |
NPI Enumeration Date: | 05/26/2016 |
NPI Last Update Date: | 05/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |