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Evergreen Group Home
Intellectual Disabilities Intermediate Care Facility in Urbana, Missouri
NPI 1841452109

Evergreen Group Home is a Intellectual Disabilities Intermediate Care Facility based in Urbana, MO. Evergreen Group Home practices in Urbana, MO. The NPI Number for Evergreen Group Home is 1841452109 and holds a License No. LC0556542 (Missouri).

The current practice location address for Evergreen Group Home is 27 Hopper Trl, Urbana, MO and can be reached out via phone at 417-722-4416 and via fax at 417-722-4417.

Location: 27 Hopper Trl, Urbana, MO, 65767-9234
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1841452109
Provider Name
Evergreen Group Home
Credential
Provider Entity Type
Organization
Address
27 Hopper Trl, Urbana, MO, 65767-9234
Phone Number
417-722-4416
Fax Number
417-722-4417
Provider Enumeration Date
06/27/2008
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
27 Hopper Trl
City
Urbana
State
Missouri
Zip
65767-9234
Phone Number
417-722-4416
Fax Number
417-722-4417
person
Provider Business Mailing Address Details
Address
27 Hopper Trl
City
Urbana
State
Missouri
Zip
65767-9234
Phone Number
417-722-4416
Fax Number
417-722-4417
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
LC0556542 (Missouri)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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