NPIMap

Organization Active NPI

Helia Healthcare of Effingham, LLC

Doing business as Evergreen Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Effingham, IL
National Provider Identifier
1962571000
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HELIA HEALTHCARE OF EFFINGHAM, LLC
Doing business as
Evergreen Nursing and Rehabilitation Center
Practice address
1115 N Wenthe
Effingham, IL 62401
Phone
(217) 347-7121
Fax
(217) 342-5525
NPI assigned
Nov 6, 2006
Last updated
Mar 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Mr. Michael Jason Mills
Title
Cfo
Phone
(314) 317-2003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1115 N Wenthe
Effingham, IL 62401

Mailing address

500 NW Plaza Dr Ste 712
Saint Ann, MO 63074-2222
Phone (314) 566-0459

Other identifiers 1

IdentifierTypeStateIssuer
200089842001MedicaidIL

Other names 1

  • EVERGREEN NURSING AND REHABILITATION CENTER Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180622000048 IL Part A Provider - Skilled Nursing Facility 4981959533 Practice locations: Effingham, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962571000. Details of each certification follow.

Skilled nursing facility certification: CCN 145628

Legal name
HELIA HEALTHCARE OF EFFINGHAM LLC
Doing business as
EVERGREEN NURSING & REHAB CTR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 14, 1989
Last certification
Oct 18, 2024
Beds
120
Ownership / control type
Corporation
Multi-facility organization
bridgemark healthcare
Most recent change of ownership
May 7, 2018
Organization structure
LLCProprietary
Incorporated
Feb 28, 2018 in IL
Enrollment address
1115 N Wenthe Dr
Effingham, IL 62401-1612
Nursing home name
EVERGREEN NURSING & REHAB CENTER
Affiliated entity
HELIA HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Evergreen Nursing & Rehab CenterCCN 145628 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
2 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 14, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12046.3 residents per day on average
Chain
Helia Healthcare13 facilities in the chain
Penalties (3 years)
1Fines totaling $10,542

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0680328Evergreen Nursing & Rehabilitation Center L L C1115 N Wenthe Ave, Effingham, IL 62401Certificate of waiverSep 4, 2027

National Provider Directory

National Provider Directory

Locations

1115 N Wenthe Dr
Effingham, IL 62401
Phone (217) 247-7121

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Stephen P Miller Individual Contracted Managing EmployeePresident Feb 28, 2018 100%
5% Or Greater Direct Ownership InterestOwner Feb 28, 2018 100%
Corporate OfficerPresident Feb 28, 2018 100%

Practitioners & affiliated clinicians

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1962571000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 NW PLAZA DR STE 712",
            "city": "SAINT ANN",
            "state": "MO",
            "postal_code": "630742222",
            "telephone_number": "314-566-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 N WENTHE",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "62401",
            "telephone_number": "217-347-7121",
            "fax_number": "217-342-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HELIA HEALTHCARE OF EFFINGHAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-317-2003",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200089842001",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "EVERGREEN NURSING AND REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Effingham, IL

Sources for this page

Verify at the official NPI Registry.