EVERGREEN GLENHAVEN OPERATIONS, LLC NPI 1013168202

Assisted Living Facility in Alton, IL

NPI 1013168202 Organization Assisted Living Facility

About EVERGREEN GLENHAVEN OPERATIONS, LLC

Evergreen Glenhaven Operations, Llc is a provider established in Alton, Illinois specializing in assisted living facility. The NPI number of Evergreen Glenhaven Operations, Llc is 1013168202 and was assigned on October 2008. The practitioner's primary taxonomy code is 310400000X with license number 3522842186220201 (IL). The provider is registered as an organization and their NPI record was last updated 5 years ago. The authorized official of this NPI record is David Underwood (Exec Vp & Cfo)

NPI

1013168202

Provider NameEVERGREEN GLENHAVEN OPERATIONS, LLC
Provider Location Address100 GLENHAVEN DR ALTON, IL 62002
Provider Mailing Address115 W JEFFERSON ST. SUITE 401 BLOOMINGTON, IL 61701
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date10-06-2008
Last Update Date05-18-2016


Primary Taxonomy

Taxonomy Code310400000X
ClassificationAssisted Living Facility
TypeNursing & Custodial Care Facilities
License No.3522842186220201
License StateIL
Taxonomy DescriptionA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Business Address

EVERGREEN GLENHAVEN OPERATIONS, LLC
100 GLENHAVEN DR
ALTON, IL
ZIP 62002
Phone: (618) 462-1500

Get Directions


Mailing Address

EVERGREEN GLENHAVEN OPERATIONS, LLC
115 W JEFFERSON ST.
SUITE 401
BLOOMINGTON, IL
ZIP 61701
Phone: (309) 828-4361



Authorized Official

Authorized Official Name DAVID UNDERWOOD
Authorized Official TitleEXEC VP & CFO
Authorized Official Phone(309) 823-7135

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
352284218001MEDICAID (05)IL

Other Providers at the same location


The following 6 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1821342486 DEBRA FISHER
Individual
Physical Therapist100 GLENHAVEN DR
ALTON, IL 62002
(618) 462-1500
1245860212 JENNY PEPPLER MS CCC/SLP
Individual
Speech-Language Pathologist100 GLENHAVEN DR
ALTON, IL 62002
(618) 462-1500
1588294490 EILEEN MARY HUGHES PTA
Individual
Physical Therapy Assistant100 GLENHAVEN DR
ALTON, IL 62002
(618) 462-1500
1164052858 SARAH ANN HOGUE
Individual
Physical Therapy Assistant100 GLENHAVEN DR
ALTON, IL 62002
(618) 462-1500
1023649761 ROBIN ILEANA FOSTER OTR/L
Individual
Occupational Therapist100 GLENHAVEN DR
ALTON, IL 62002
(618) 462-1500
1366048381 ALLISON JANE LUND PTA
Individual
Physical Therapy Assistant100 GLENHAVEN DR
ALTON, IL 62002
(618) 978-8080

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.