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EVERGREEN PLACE BEARDSTOWN LLC
NPI 1063974418
Assisted Living Facility in Beardstown, IL

Active since April 04, 2019CLIA 14D2194622 · Waiver
8570 SAINT LUKES DR, BEARDSTOWN, IL 62618(217) 323-1860 Get Directions Write a Review

NPPES record last updated: April 4, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Evergreen Place Beardstown Llc NPPES

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

EVERGREEN PLACE BEARDSTOWN LLC (NPI 1063974418), doing business as Evergreen Place, is a healthcare organization registered as an assisted living facility in Beardstown, Illinois and active in the NPI registry since April 2019. The organization holds a CLIA Waiver certificate valid through September 30, 2026 and lists David M Underwood, Exec Vp Finance & Cfo, as its authorized official.

NPPES Registry Identity

NPI1063974418
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEVERGREEN PLACE BEARDSTOWN LLC
Location Address8570 SAINT LUKES DRBeardstown, IL 62618-9200
Mailing Address115 W Jefferson St Ste 401Bloomington, IL 61701-3967 · (309) 823-7139
Phone(217) 323-1860
Organization SubpartYesParent: Heritage Enterprises, Inc.
Authorized OfficialDavid M UnderwoodExec Vp Finance & Cfo · (309) 823-7135
Enumeration DateApril 4, 2019
✔ NPI 1063974418 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
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.
8570 SAINT LUKES DR, Beardstown, IL 62618
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Other Names 1

Doing Business AsEvergreen Place

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D2194622

Evergreen Place · Beardstown, IL
Active · expires Sep 30, 2026
CLIA Number14D2194622
Laboratory TypeSupportive Living Fac
Certificate Effective DateOctober 1, 2024
Certificate Expiration DateSeptember 30, 2026
Laboratory DirectorMelissa Burke
Laboratory Phone(217) 323-1860
Laboratory LocationEvergreen Place8570 St Lukes Dr, Beardstown, IL 62618
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

BEARDSTOWN SUPPORTIVE LIVING LLC
Assisted Living Facility
8570 SAINT LUKES DR
BEARDSTOWN, IL 62618
Cass County (217) 323-1860
HERITAGE ENTERPRISES, INC.
Assisted Living Facility
8570 SAINT LUKES DR
BEARDSTOWN, IL 62618
Cass County (217) 323-4055
EMILY HALL
Occupational Therapy Assistant
8570 SAINT LUKES DR
BEARDSTOWN, IL 62618
Cass County (217) 370-7347

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 Place Beardstown LLC's NPI number?

The NPI number for Evergreen Place Beardstown LLC is 1063974418. It was assigned to this organization in the NPPES registry on April 4, 2019. The provider is doing business as Evergreen Place.

Where is Evergreen Place Beardstown LLC located?

Evergreen Place Beardstown LLC is located at 8570 Saint Lukes Dr, Beardstown, IL 62618. The listed phone number is (217) 323-1860.

What is Evergreen Place Beardstown LLC's specialty?

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

Does Evergreen Place Beardstown LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2194622) is associated with this NPI, valid through September 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Evergreen Place Beardstown LLC was last updated on April 4, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.