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EVERGREEN GLENHAVEN OPERATIONS, LLC
NPI 1013168202
Assisted Living Facility in Alton, IL

Active since October 06, 2008
100 GLENHAVEN DR, ALTON, IL 62002(618) 462-1500 Get Directions Write a Review

NPPES record last updated: May 18, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Evergreen Glenhaven Operations, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN GLENHAVEN OPERATIONS, LLC (NPI 1013168202) is a healthcare organization registered as an assisted living facility in Alton, Illinois and active in the NPI registry since October 2008. The organization lists David Underwood, Exec Vp & Cfo, as its authorized official.

NPPES Registry Identity

NPI1013168202
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEVERGREEN GLENHAVEN OPERATIONS, LLC
Location Address100 GLENHAVEN DRAlton, IL 62002-6700
Mailing Address115 W Jefferson St., Suite 401Bloomington, IL 61701 · (309) 828-4361
Phone(618) 462-1500
Organization SubpartNo
Authorized OfficialDavid UnderwoodExec Vp & Cfo · (309) 823-7135
Enumeration DateOctober 6, 2008
Last NPPES UpdateMay 18, 2016
✔ NPI 1013168202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in IL · 3522842186220201
Definition

A 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.

100 GLENHAVEN DR, Alton, IL 62002
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Other Identifiers 1

Medicaid352284218001IL

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBIN ILEANA FOSTER OTR/L
Occupational Therapist
100 GLENHAVEN DR
ALTON, IL 62002
Madison County (618) 462-1500
SARAH ANN HOGUE
Physical Therapy Assistant
100 GLENHAVEN DR
ALTON, IL 62002
Madison County (618) 462-1500
JENNY PEPPLER MS CCC/SLP
Speech-Language Pathologist
100 GLENHAVEN DR
ALTON, IL 62002
Madison County (618) 462-1500
ALLISON JANE LUND PTA
Physical Therapy Assistant
100 GLENHAVEN DR
ALTON, IL 62002
Madison County (618) 978-8080
EILEEN MARY HUGHES PTA
Physical Therapy Assistant
100 GLENHAVEN DR
ALTON, IL 62002
Madison County (618) 462-1500
DEBRA FISHER
Physical Therapist
100 GLENHAVEN DR
ALTON, IL 62002
Madison County (618) 462-1500
MOHINI N SHAH OTR/L
Occupational Therapist
100 GLENHAVEN DR
ALTON, IL 62002
Madison County (618) 462-1500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Glenhaven Operations, LLC's NPI number?

The NPI number for Evergreen Glenhaven Operations, LLC is 1013168202. It was assigned to this organization in the NPPES registry on October 6, 2008.

Where is Evergreen Glenhaven Operations, LLC located?

Evergreen Glenhaven Operations, LLC is located at 100 Glenhaven Dr, Alton, IL 62002. The listed phone number is (618) 462-1500.

What is Evergreen Glenhaven Operations, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Evergreen Glenhaven Operations, LLC was last updated on May 18, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.