EVERGREEN GROUP HOME, LLC (NPI# 1871638999) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871638999 |
| Entity Type | Organization |
| Organization Name | EVERGREEN GROUP HOME, LLC |
| Other Organization Name | EVERGREEN GROUP HOME |
| Practice Address |
27 Hopper Trl Urbana MO 65767-9234 |
| Practice Telephone | 4177224416 |
| Practice Fax Number | 4177224417 |
| Mailing Telephone | 4177224416 |
| Mailing Fax Number | 4177224417 |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. GARY D BOGGS (PRESIDENT) |
| Authorized Official Telephone | 4177224416 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
91438201670000 | MO | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Evergreen Group Home | Doing Business As Name - Organization |
| Street Address |
27 HOPPER TRL |
| City | URBANA |
| State | MO |
| Zip Code | 65767-9234 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841452109 | Evergreen Group Home | Intermediate Care Facility, Mentally Retarded | 27 Hopper Trl, Urbana, MO 65767-9234 | 2008-06-27 |
| 1093977365 | Applewood Lane Corporation | Intermediate Care Facility, Mentally Retarded | 27 Hopper Trl, Urbana, MO 65767-9234 | 2008-06-27 |
| 1215055371 | Lakeshores Residential Care Facility | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 27 Hopper Trl, Urbana, MO 65767-9234 | 2007-03-27 |
| 1750408365 | Applewood In-home Health | Nursing Care | 27 Hopper Trl, Urbana, MO 65767-9234 | 2007-03-26 |
| 1407973597 | Applewood In-home Health | Home Health | 27 Hopper Trl, Urbana, MO 65767-9234 | 2007-03-23 |
| 1447375084 | Pineview Group Home | Intermediate Care Facility, Mental Illness | 27 Hopper Trl, Urbana, MO 65767-9234 | 2007-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508839986 | Judith A Taylor | Family Medicine | 311 W Broadway, Urbana, MO 65767 | 2006-02-08 |
| 1467070227 | Kimberly Renee Choate | Social Worker | 111 Main St, Urbana, MO 65767 | 2020-07-08 |
| 1073838199 | A New Hope Hospice | Hospice Care, Community Based | 16 Pleasant Ridge Dr, Urbana, MO 65767-8121 | 2010-03-31 |
| 1528021565 | Urbana Medical Clinic, L.L.C. | Family Medicine | 311 W Broadway St, Urbana, MO 65767-9101 | 2006-04-10 |
| 1760731053 | Christian Home Care LLC | In Home Supportive Care | 311 W Broadway St, Urbana, MO 65767-9101 | 2012-09-03 |
| 1487024667 | Ozarks Resource Group | Clinic/Center | 111 N Main St, Urbana, MO 65767-9152 | 2015-10-01 |
| 1699808279 | Car Dieus Enterprises | Day Training, Developmentally Disabled Services | 211 N Main St, Urbana, MO 65767-9164 | 2007-03-13 |
| 1609333624 | Urbana Rest Home | Community Based Residential Treatment Facility, Mental Illness | 310 Walnut St, Urbana, MO 65767-9208 | 2019-02-26 |
| 1548734957 | Marion Lynn Bailey | Community Based Residential Treatment Facility, Mental Illness | 310 Walnut St, Urbana, MO 65767-9208 | 2019-01-18 |
| 1033234919 | Beacon Hill Group Home | Intermediate Care Facility, Mental Illness | 399 State Road Bb, Urbana, MO 65767-9253 | 2007-03-20 |
| Find all providers in zip 65767 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861090250 | Christiana Michelle King | Counselor | 3510 Worthington Blvd Unit 101, Urbana, MD 21704-7066 | 2020-10-16 |
| 1396375358 | Maliya Smith | Counselor | 1101 Clifford Dr Apt 6, Urbana, IL 61802-6815 | 2020-01-17 |
| 1376825398 | Shilpa S Jhobalia | Counselor | 1606 Willow View Rd, Suite 2e, Urbana, IL 61802-7475 | 2011-09-15 |
| 1508088303 | Carle Clinic Resolutions Eap | Counselor | 204 W University Ave, Urbana, IL 61801-1741 | 2007-05-02 |
| 1497840029 | Joanna Kling | Counselor | 507 W. Springfield Ave., Urbana, IL 61801 | 2006-10-03 |
| 1518050392 | Martha S. Jarmuz | Counselor | 102 E Main St Ste 403, Urbana, IL 61801-2744 | 2006-10-02 |
| 1215048327 | Susan Kathleen Kiener Keller | Counselor | 1011 W Springfield Ave, Urbana, IL 61801-3022 | 2006-08-31 |
| 1750751962 | Counseling You Through LLC | Counselor | 1606 Willow View Rd, Suite 2e, Urbana, IL 61802-7475 | 2015-09-30 |
| 1902295405 | Marcia Kostoff | Counselor | 1522 E Us Highway 36, Suite A, Urbana, OH 43078-9738 | 2015-01-21 |
| 1023313376 | Ruth Eileen Montgomery | Counselor | 1150 Scioto St, Suite 200, Urbana, OH 43078-2289 | 2011-01-18 |
| Find all providers in URBANA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.