Evergreen Place Decatur, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVERGREEN PLACE DECATUR, LLC

Doing business as

Evergreen Place Decatur Supportive Living

Practice address

4825 E Evergreen Court
Decatur, IL 62521

Phone

(217) 864-4300

Fax

(217) 864-4321

NPI assigned

Feb 8, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Craig L Ater

Title

Exec VP & Cfo

Phone

(309) 823-7135

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Place Decatur Supportive Living Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329436800000",
    "number": "1003188913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W JEFFERSON ST STE 401",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013967",
            "telephone_number": "309-823-7155",
            "fax_number": "309-829-9512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4825 E EVERGREEN COURT",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "62521",
            "telephone_number": "217-864-4300",
            "fax_number": "217-864-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PLACE DECATUR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-08",
        "last_updated": "2012-02-17",
        "status": "A",
        "authorized_official_last_name": "ATER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXEC VP & CFO",
        "authorized_official_telephone_number": "309-823-7135",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Place Decatur Supportive Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Decatur, IL
• Providers in Decatur, IL by specialty
• Assisted Living Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.