EVERGREEN VILLAGE SUPPORTIVE LIVING, L.L.C.
NPI 1629247283
Assisted Living Facility in Normal, IL
NPI Status: Active since February 27, 2008
Contact Information
1701 EVERGREEN VILLAGE BLVD
NORMAL, IL
ZIP 61761
Phone: (309) 452-7300
Fax: (309) 452-7311
- Organization
- Assisted Living Facility
- CLIA Number: 14D2194722
- CLIA Cert. Type: Other - SUPPORTIVE LIVING FAC
- CLIA Exp. Date: 10-01-2026
About EVERGREEN VILLAGE SUPPORTIVE LIVING, L.L.C.
This page provides the complete NPI Profile along with additional information for Evergreen Village Supportive Living, L.l.c., a provider established in Normal, Illinois operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1629247283 assigned on February 2008. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 18 years ago. The provider's is doing business as Evergreen Village Supportive Living, L.l.c.. The authorized official of this NPI record is Mr. Craig L. Ater (Senior V. P. Of Finance)
- NPI
- 1629247283
- Provider Legal Name
- MCLEAN COUNTY ASSISTED LIVING, L.L.C.
- Other Organization Name
- EVERGREEN VILLAGE SUPPORTIVE LIVING, L.L.C.
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1701 EVERGREEN VILLAGE BLVD NORMAL, IL 61761
- Location Phone
- (309) 452-7300
- Location Fax
- (309) 452-7311
- Mailing Address
- 115 W JEFFERSON ST SUITE 401, PO BOX 3188 BLOOMINGTON, IL 61701
- Mailing Phone
- (309) 823-7155
- Mailing Fax
- (309) 452-7311
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 02-27-2008
- Last Update Date
- 08-06-2008
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License State
- IL
- Taxonomy Description
- 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.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 205051684001 | MEDICAID (05) | IL |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D2194722
- Facility Type
- Other - SUPPORTIVE LIVING FAC
- Certificate Effective Date
- October 02, 2024
- Certificate Expiration Date
- October 01, 2026
- Laboratory Director
- KRIS LOUDENBACK
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Evergreen Village Supportive Living, L.l.c. to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1629247283, we treat the final digit (3) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 67. The final step is to find the difference between that total and the next multiple of ten (70 - 67 = 3).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 67 is 70. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1629247283, enumerated as an "organization" on February 27, 2008.
The provider is located at 1701 EVERGREEN VILLAGE BLVD NORMAL, IL 61761 and the phone number is (309) 452-7300.
Assisted Living Facility with taxonomy code 310400000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
