EVERGREEN PRESBYTERIAN MINISTRIES, INC. (NPI# 1356499040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356499040 |
| Entity Type | Organization |
| Organization Name | EVERGREEN PRESBYTERIAN MINISTRIES, INC. |
| Other Organization Name | TERRACE DRIVE COMMUNITY HOME |
| Practice Address |
3315 Terrace Dr Shreveport LA 71107-3932 |
| Mailing Address |
2101 Highway 80 Haughton LA 71037-9488 |
| Practice Telephone | 3182268940 |
| Mailing Telephone | 3189495500 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2008-06-12 |
| Authorized Official Name | JOHN R TAYLOR (PRESIDENT) |
| Authorized Official Telephone | 3189495500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 164 | LA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1715140 | 05 |
| Other Name | Type Code |
|---|---|
| Terrace Drive Community Home | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720539299 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15212 Wadesboro Dr., Ponchatoula, LA 70454 | 2016-10-20 |
| 1770931503 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 24345 Harvey Lavigne Road, Ponchatoula, LA 70454 | 2016-06-02 |
| 1265880488 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3622 Groom Road, Baker, LA 70714 | 2016-05-27 |
| 1679921860 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 10599 Gatlin Road, Hammond, LA 70403 | 2016-05-27 |
| 1376991570 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15822 Demarco Lane, Hammond, LA 70403 | 2016-05-27 |
| 1700234903 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 42175 Billville Road, Hammond, LA 70403 | 2016-05-27 |
| 1518315738 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5636 Brownfield Road, Baton Rouge, LA 70808 | 2016-05-27 |
| 1306294731 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 21147 Highway 22, Ponchatoula, LA 70454-7941 | 2016-05-26 |
| 1316393531 | Evergreen Presbyterian Ministries, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1538 Camellia Dr, Hammond, LA 70403-6228 | 2016-05-06 |
| 1881049211 | Evergreen Presbyterian Ministries, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 103 East Pecan St., Ponchatoula, LA 70454 | 2016-05-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EVERGREEN PRESBYTERIAN MINISTRIES, INC. | 2101 Hwy 80, Haughton, LA 71037-9488 |
| Street Address |
3315 TERRACE DR |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71107-3932 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306490875 | Kimber Leigh Lumley | Registered Nurse | 1440 Hawn Ave., Shreveport, LA 71107 | 2019-08-01 |
| 1871063461 | Nicole Capito | Case Manager/Care Coordinator | 200 North Thomas Drive Ste 1, Shreveport, LA 71107 | 2018-11-27 |
| 1891260899 | Danielle Leigh Dreher | Dental Assistant | 3610 Gorman Rd, Shreveport, LA 71107 | 2018-10-05 |
| 1255817540 | Shirley Marie Washington | Technician | 3227 Old Mooringsport Rd., Shreveport Rd, LA 71107 | 2018-07-19 |
| 1366928467 | Katrina L Bailey | Case Manager/Care Coordinator | 1111 Hawn Ave Apt A, Shreveport, LA 71107 | 2018-07-12 |
| 1063907970 | James Mcneely IIi | Public Health or Welfare | 5922 Alaska Ln, Shreveport, LA 71107 | 2018-06-25 |
| 1528560067 | Jacarie Guice | Case Manager/Care Coordinator | 4601 N. Market Ste 2, Shreveport, LA 71107 | 2018-03-01 |
| 1467971069 | Tracy Renard Harris | Counselor | 1149 Englemeade Dr, Shreveport, LA 71107 | 2017-09-14 |
| 1427588045 | Mark Rogers | Behavior Technician | 1500 N. Market Unit C Suite 105, Shreveport, LA 71107 | 2017-06-15 |
| 1356871164 | Hope4youth | Voluntary or Charitable | 2850 King Oaks Loop, Shreveport, LA 71107 | 2017-06-14 |
| Find all providers in zip 71107 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457409153 | Evergreen Presbyterian Ministries, Inc. | Intermediate Care Facility, Mentally Retarded | 181 Carroll St, Shreveport, LA 71105-4234 | 2007-01-08 |
| 1104974781 | Evergreen Presbyterian Ministries, Inc. | Intermediate Care Facility, Mentally Retarded | 4520 Gilbert Dr, Shreveport, LA 71106-1646 | 2007-01-08 |
| 1306994785 | Evergreen Presbyterian Ministries, Inc. | Intermediate Care Facility, Mentally Retarded | 815 Ravendale Dr, Shreveport, LA 71107-4026 | 2007-01-08 |
| 1356499925 | Evergreen Presbyterian Ministries, Inc. | Intermediate Care Facility, Mentally Retarded | 412 S Dresden Cir, Shreveport, LA 71115-2907 | 2007-01-08 |
| 1952459653 | Evergreen Presbyterian Ministries, Inc. | Intermediate Care Facility, Mentally Retarded | 3111 Country Club Dr, Shreveport, LA 71109-3906 | 2007-01-08 |
| 1942360557 | Evergreen Presbyterian Ministries, Inc. | Intermediate Care Facility, Mentally Retarded | 319 Meadowbrook Ln, Shreveport, LA 71105-4315 | 2006-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174136527 | St. Mary's Residential Training School | Intermediate Care Facility, Mentally Retarded | 1901 Huie Dellmon Ave, Boyce, LA 71409-9329 | 2020-08-26 |
| 1174136535 | St. Mary's Residential Training School | Intermediate Care Facility, Mentally Retarded | 1903 Huie Dellmon Ave, Boyce, LA 71409-9329 | 2020-08-26 |
| 1427613371 | Lisa Williams | Intermediate Care Facility, Mentally Retarded | 1202 St. Maurice Ave, New Orleans, LA 70117-7011 | 2019-05-07 |
| 1700324084 | Magnolia Community Services, Inc | Intermediate Care Facility, Mentally Retarded | 821 Jefferson Heights Ave., Jefferson, LA 70121 | 2017-02-07 |
| 1801260468 | Magnolia Community Services, Inc | Intermediate Care Facility, Mentally Retarded | 143 Central Ave, Jefferson, LA 70121-3401 | 2015-11-19 |
| 1669867545 | Wendover Community Home | Intermediate Care Facility, Mentally Retarded | 4607 Wendover Blvd, Alexandria, LA 71303-2528 | 2015-03-30 |
| 1538554423 | West Pointe Community Home | Intermediate Care Facility, Mentally Retarded | 6218 W Pointe Blvd, Alexandria, LA 71303-2000 | 2015-03-30 |
| 1073904389 | Normal Life of Louisiana, Inc. | Intermediate Care Facility, Mentally Retarded | 15460 Tracey Ln, Independence, LA 70443-2470 | 2015-02-09 |
| 1306276639 | The Arc of Sabine Inc | Intermediate Care Facility, Mentally Retarded | 200 Dockens Dr, Many, LA 71449-3852 | 2013-11-22 |
| 1326304445 | Cdf Healthcare of La, LLC | Intermediate Care Facility, Mentally Retarded | 596 Midway Church Lane, Delhi, LA 71232 | 2012-04-03 |
| Find all providers with the same taxonomy | ||||
| City | SHREVEPORT |
| Zip Code | 71107 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.