Provider Demographics
NPI:1588737159
Name:EVERGREEN PRESBYTERIAN MINISTRIES OF TEXAS, INC.
Entity type:Organization
Organization Name:EVERGREEN PRESBYTERIAN MINISTRIES OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-742-8440
Mailing Address - Street 1:PO BOX 72360
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71172-2360
Mailing Address - Country:US
Mailing Address - Phone:318-742-8440
Mailing Address - Fax:318-752-5459
Practice Address - Street 1:10810 SANDEN DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1337
Practice Address - Country:US
Practice Address - Phone:972-386-4834
Practice Address - Fax:972-386-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities