Organization Name: | EVERGREEN PLACE DECATUR, LLC |
NPI Number: | 1003188913 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CRAIG L ATER (EXEC VP & CFO) |
Mailing Address: | 4825 E Evergreen Court Decatur |
State: | IL US |
Postal Code: | 62521 |
Phone Number: | 2178644300 |
Fax Number: | 2178644321 |
NPI Enumeration Date: | 02/08/2012 |
NPI Last Update Date: | 02/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy 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. |