MCLEAN COUNTY ASSISTED LIVING L.L.C. NPI 1629247283

NPI Information

  • NPI: 1629247283
  • Provider Name: MCLEAN COUNTY ASSISTED LIVING, L.L.C.
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: EVERGREEN VILLAGE SUPPORTIVE LIVING, L.L.C.
  • CLIA Number: 14D2194722
  • Address: 1701 EVERGREEN VILLAGE BLVD
    NORMAL, IL
    ZIP 61761
  • Phone: (309) 452-7300

Map and Directions

Get Directions

NPI Details

MCLEAN COUNTY ASSISTED LIVING, L.L.C. is an assisted living facility in Normal, 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. MCLEAN COUNTY ASSISTED LIVING, L.L.C. NPI is 1629247283. The provider is registered as an organization entity type.
The provider Is Doing Business As Evergreen Village Supportive Living, L.l.c..

The provider's business location address is:

1701 EVERGREEN VILLAGE BLVD
NORMAL, IL
ZIP 61761
Phone: (309) 452-7300
Fax: (309) 452-7311

The provider's authorized official is Craig L. Ater .
The authorized official title is Senior V. P. Of Finance and has the following contact phone number (309) 823-7135.

The CLIA number assigned to this NPI record is 14D2194722 - other - supportive living fac with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/27/2008 and was last updated on 8/6/2008.

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 FacilityILLINOISYes

Other Identifiers

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

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1205051684001MEDICAIDILLINOIS

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: 11/21/2025

NPI Synchronization or Removal

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.

Previous NPI
Next NPI