Evergreen Streator, L.P.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVERGREEN STREATOR, L.P.

Practice address

1529 E Main St
Streator, IL 61364-3162

Phone

(815) 672-0903

Fax

(815) 672-0639

NPI assigned

Nov 24, 2008

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

Senior V.P. of Finance

Phone

(309) 828-4361

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Place of Streator Supportive Living Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227484800000",
    "number": "1295980852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W JEFFERSON ST",
            "address_2": "STE 401, PO BOX 3188",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013946",
            "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": "1529 E MAIN ST",
            "city": "STREATOR",
            "state": "IL",
            "postal_code": "613643162",
            "telephone_number": "815-672-0903",
            "fax_number": "815-672-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN STREATOR, L.P.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-24",
        "last_updated": "2008-11-24",
        "status": "A",
        "authorized_official_last_name": "ATER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "SENIOR V.P. OF FINANCE",
        "authorized_official_telephone_number": "309-828-4361",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Place of Streator Supportive Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Streator, IL
• Providers in Streator, 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 Nov 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.