NPI 1013168202

Evergreen Glenhaven Operations, LLC

Organisation Assisted Living Facility Alton, IL

Practice location

Address: 100 Glenhaven Dr, Alton, IL 62002-6700
Phone: (618) 462-1500
Mailing address: 115 W Jefferson St. Suite 401, Bloomington, IL 61701

Authorised official

Name: David Underwood
Title: Exec Vp & Cfo
Phone: (309) 823-7135

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X Licence 3522842186220201 (IL)

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Registry record

NPI: 1013168202
Entity type: Organization
NPI issued: 6 Oct 2008
Record last updated: 18 May 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.