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EVERGREEN PLACE BEARDSTOWN LLC NPI 1063974418


NPI Information

NPI: 1063974418
Provider Name: EVERGREEN PLACE BEARDSTOWN LLC
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 14D2194622

Address:
8570 SAINT LUKES DR
BEARDSTOWN, IL
ZIP 62618
Phone: (217) 323-1860
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EVERGREEN PLACE BEARDSTOWN LLC is an assisted living facility in Beardstown, IL. The provider is 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. EVERGREEN PLACE BEARDSTOWN LLC NPI is 1063974418. The provider is registered as an organization entity type.

The provider's business location address is:

8570 SAINT LUKES DR
BEARDSTOWN, IL
ZIP 62618-200
Phone: (217) 323-1860

The provider's authorized official is David M Underwood .
The authorized official title is Exec Vp Finance & Cfo and has the following contact phone number (309) 823-7135.

The CLIA number assigned to this NPI record is 14D2194622 - other - supportive living fac with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/4/2019 and was last updated on 4/4/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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