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NPI Code Detail

MEDICARE: SL EVERGREEN, LLC

MEDICARE: SL EVERGREEN, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living FacilityOHL01635OH

General Provider Information

NPI Number : 1609191568
Entity Type Code : Organization
Provider Name (Legal Business Name) : SL EVERGREEN, LLC
Provider Business Mailing Address
First Line : 230 W GALBRAITH RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45215-5223
Country : US
Telephone Number : 513-948-2308
Fax Number : 513-948-0063
Provider Business Practice Location Address
First Line : 230 W GALBRAITH RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45215-5223
Country : US
Telephone Number : 513-948-2308
Fax Number : 513-948-0063
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DAVID LEE RICHEY
Credential : LNHA
Telephone Number : 513-948-2308
Provider Enumeration Date : 04/05/2010
Last Update Date : 04/05/2010

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Directions to “SL EVERGREEN, LLC ” Practice Location

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