EVERGREEN GLENHAVEN OPERATIONS LLC NPI 1013168202

NPI Information

EVERGREEN GLENHAVEN OPERATIONS, LLC is an assisted living facility in Alton, 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 GLENHAVEN OPERATIONS, LLC NPI is 1013168202. The provider is registered as an organization entity type.

The provider's business location address is:

100 GLENHAVEN DR
ALTON, IL
ZIP 62002-700
Phone: (618) 462-1500

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

The CLIA number assigned to this NPI record is 14D2194605 - other - supportive living fac with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/6/2008 and was last updated on 5/18/2016.

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:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.