Provider Demographics
NPI:1609191568
Name:SL EVERGREEN, LLC
Entity Type:Organization
Organization Name:SL EVERGREEN, LLC
Other - Org Name:EVERGREEN RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:513-948-2308
Mailing Address - Street 1:230 W GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-5223
Mailing Address - Country:US
Mailing Address - Phone:513-948-2308
Mailing Address - Fax:513-948-0063
Practice Address - Street 1:230 W GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-5223
Practice Address - Country:US
Practice Address - Phone:513-948-2308
Practice Address - Fax:513-948-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOHL01635310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility