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EVERGREEN VILLAGE SUPPORTIVE LIVING, L.L.C.
NPI 1629247283
Assisted Living Facility in Normal, IL

Active since February 27, 2008CLIA 14D2194722 · Waiver
1701 EVERGREEN VILLAGE BLVD, NORMAL, IL 61761(309) 452-7300(309) 452-7311 Get Directions Write a Review

NPPES record last updated: August 6, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Evergreen Village Supportive Living, L.l.c. NPPES

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

EVERGREEN VILLAGE SUPPORTIVE LIVING, L.L.C. (NPI 1629247283) is a healthcare organization registered as an assisted living facility in Normal, Illinois and active in the NPI registry since February 2008. The organization holds a CLIA Waiver certificate valid through October 1, 2026 and lists Craig L. Ater, Senior V. P. Of Finance, as its authorized official.

NPPES Registry Identity

NPI1629247283
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameMCLEAN COUNTY ASSISTED LIVING, L.L.C.
Location Address1701 EVERGREEN VILLAGE BLVDNormal, IL 61761
Mailing Address115 W Jefferson St, Suite 401, Po Box 3188Bloomington, IL 61701-3946 · (309) 823-7155 · Fax (309) 829-9512
Phone(309) 452-7300
Fax(309) 452-7311
Organization SubpartYes
Authorized OfficialCraig L. AterSenior V. P. Of Finance · (309) 823-7135
Enumeration DateFebruary 27, 2008
Last NPPES UpdateAugust 6, 2008
✔ NPI 1629247283 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.
1701 EVERGREEN VILLAGE BLVD, Normal, IL 61761
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Other Names 1

Doing Business AsEvergreen Village Supportive Living, L.l.c.

Other Identifiers 1

Medicaid205051684001IL

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 14D2194722

Evergreen Village · Normal, IL
Active · expires Oct 1, 2026
CLIA Number14D2194722
Laboratory TypeSupportive Living Fac
Certificate Effective DateOctober 2, 2024
Certificate Expiration DateOctober 1, 2026
Laboratory DirectorKris Loudenback
Laboratory Phone(309) 452-7300
Laboratory LocationEvergreen Village1701 Evergreen Village Blvd, Normal, IL 61761
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Mclean County Assisted Living, L.L.C.'s NPI number?

The NPI number for Mclean County Assisted Living, L.L.C. is 1629247283. It was assigned to this organization in the NPPES registry on February 27, 2008. The provider is doing business as Evergreen Village Supportive Living, L.L.C..

Where is Mclean County Assisted Living, L.L.C. located?

Mclean County Assisted Living, L.L.C. is located at 1701 Evergreen Village Blvd, Normal, IL 61761. The listed phone number is (309) 452-7300.

What is Mclean County Assisted Living, L.L.C.'s specialty?

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

Does Mclean County Assisted Living, L.L.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D2194722) is associated with this NPI, valid through October 1, 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 Mclean County Assisted Living, L.L.C. was last updated on August 6, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.